Introduction
Methods
Study design and study population
Dietary assessment
Food variety, dietary diversity, and dietary patterns
No. FVS | FVS food group | Scoring criteria (0–20 points) | No. DDS | DDS food category | Scoring criteria (0–7 points) |
---|---|---|---|---|---|
1 | Starchy roots, tubers, and plantain | At least once per week (0 vs. 1 point) | 1 | Staples | At least once per day each food group of the category (0 vs. 1 point) |
2 | Fermented maize products | ||||
3 | Bread and cereals | ||||
4 | Rice and pasta | ||||
5 | Dairy products | 2 | Dairy | ||
6 | Fish and seafood | 3 | Meat and alternatives (protein) | ||
7 | Red meat, incl. offals | ||||
8 | Processed meat | ||||
9 | Poultry | ||||
10 | Eggs | ||||
11 | Legumes | ||||
12 | Nuts and seeds | 4 | Fruits | ||
13 | Fruits | ||||
14 | Vegetables | 5 | Vegetables | ||
15 | Fats and oils | 6 | Fats and oils | ||
16 | Sweets | ||||
17 | Cakes and cookies | ||||
18 | Soft drinks and juices | 7 | Beverages | ||
19 | Coffee and tea | ||||
20 | Alcoholic beverages |
Assessment of covariates
Statistical analysis
Results
Study population
Food variety, dietary diversity, and dietary patterns
Variety score and score components | Total | Rural Ghana | Urban Ghana | Europe |
---|---|---|---|---|
N
| 3810 | 870 | 1364 | 1576 |
Food Variety Score (FVS) | 12.4 ± 0.05 | 10.9 ± 0.09 | 12.3 ± 0.08* | 13.4 ± 0.07* |
Dietary Diversity Score (DDS) | 5.9 ± 0.02 | 5.3 ± 0.03 | 5.6 ± 0.04* | 6.3 ± 0.02* |
Diet Quality Index-International (DQI-I) Variety | 15.7 ± 0.07 | 15.1 ± 0.14 | 15.6 ± 0.11* | 16.0 ± 0.10* |
DQI-I overall food group variety (meat/poultry/fish/eggs; dairy/beans; grain; fruit; vegetable) | ||||
≥ 1 serving/day from each food group = 15 | 38.1 (36.6, 39.7) | 37.5 (34.3, 40.7) | 40.3 (37.7, 42.9) | 36.6 (34.2, 39.0) |
Any one food group missing/day = 12 | 38.1 (36.5, 39.6) | 41.2 (37.9, 44.4) | 35.0 (32.5, 37.6) | 39.0 (36.6, 41.4) |
Any two food groups missing/day = 9 | 17.7 (16.5, 18.9) | 16.3 (13.9, 18.8) | 16.7 (14.7, 18.7) | 19.3 (17.3, 21.2) |
Any three food groups missing/day = 6 | 5.5 (4.8, 6.3) | 4.3 (2.9, 5.6) | 7.5 (6.1, 8.9) | 4.6 (3.5, 5.6) |
≥ 4 food groups missing/day = 3 | 0.6 (0.3, 0.8) | 0.8 (0.2, 1.4) | 0.5 (0.1, 0.9) | 0.5 (0.2, 0.9) |
None from any food groups = 0 | 0.0 (0.0, 0.0) | 0.0 (0.0, 0.0) | 0.0 (0.0, 0.0) | 0.0 (0.0, 0.0) |
DQI-I within-food group variety for protein source (meat, poultry, fish, dairy, beans, eggs) | ||||
≥ 3 different sources/day = 5 | 64.9 (63.3, 66.4) | 50.5 (47.1, 53.8) | 63.9 (61.4, 66.5) | 73.6 (71.4, 75.8) |
Two different sources/day = 3 | 2.6 (2.1, 3.1) | 3.0 (1.9, 4.1) | 2.7 (1.9, 3.6) | 2.3 (1.6, 3.0) |
One source/day = 1 | 12.7 (11.6, 13.7) | 17.4 (14.8, 19.9) | 14.6 (12.7, 16.5) | 8.4 (7.0, 9.7) |
None = 0 | 19.9 (18.6, 21.2) | 29.2 (26.2, 32.2) | 18.8 (16.7, 20.8) | 15.7 (13.9, 17.5) |
Correlation coefficients | Mixed dietary pattern | Rice, pasta, meat and fish dietary pattern | Roots, tubers and plantain dietary pattern | ||||||
---|---|---|---|---|---|---|---|---|---|
Rural Ghana | Urban Ghana | Europe | Rural Ghana | Urban Ghana | Europe | Rural Ghana | Urban Ghana | Europe | |
FVS |
0.19
|
0.16
|
0.26
|
0.58
|
0.58
|
0.43
| 0.06 |
0.19
|
0.17
|
DDS |
0.18
|
0.21
|
0.30
|
0.30
|
0.24
|
0.19
| −0.01 |
0.23
|
0.20
|
DQI-I variety | −0.01 | 0.02 |
0.12
|
0.31
|
0.28
|
0.24
|
0.15
|
0.16
|
0.11
|
Food variety, dietary diversity, and type 2 diabetes
Dietary score | Per 1 score point | Per 1 standard deviation of the score |
p for interaction with study site | ||
---|---|---|---|---|---|
OR (95% CI) |
p
| OR (95% CI) |
p
| ||
Food Variety Score (FVS) | |||||
Model 1 | 0.92 (0.88, 0.96) | 0.0001 | 0.79 (0.70, 0.89) | 0.0001 | 0.560 |
Model 2 | 0.94 (0.89, 0.98) | 0.006 | 0.83 (0.72, 0.95) | 0.006 | 0.450 |
Model 3 | 0.93 (0.89, 0.98) | 0.003 | 0.81 (0.71, 0.93) | 0.003 | 0.318 |
Dietary Diversity Score (DDS) | |||||
Model 1 | 1.00 (0.89, 1.11) | 0.929 | 1.00 (0.88, 1.12) | 0.929 | 0.939 |
Model 2 | 1.05 (0.94, 1.18) | 0.396 | 1.06 (0.93, 1.20) | 0.396 | 0.828 |
Model 3 | 1.05 (0.94, 1.18) | 0.420 | 1.06 (0.93, 1.20) | 0.420 | 0.760 |
DQI-I variety component | |||||
Model 1 | 1.00 (0.97, 1.03) | 0.925 | 0.99 (0.86, 1.14) | 0.925 | 0.489 |
Model 2 | 1.00 (0.97, 1.03) | 0.975 | 1.00 (0.87, 1.15) | 0.975 | 0.497 |
Model 3 | 1.00 (0.96, 1.03) | 0.874 | 0.99 (0.86, 1.14) | 0.874 | 0.389 |
Model | Odds ratio (95% confidence interval) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Q1 | Q2 | Q3 | Q4 | Q5 |
p trend | Per 1 score-SD | ||||||
Mixed dietary pattern | ||||||||||||
Diabetes/controls | 70/690 | 59/690 | 54/691 | 89/690 | 87/690 | |||||||
Adjusted model | 1.00 | 0.79 | 0.54–1.16 | 0.76 | 0.50–1.15 | 0.89 | 0.49–1.61 | 0.84 | 0.44–1.62 | 0.601 | 1.00 | 0.81–1.23 |
+ FVS | 1.00 | 0.82 | 0.56–1.20 | 0.81 | 0.54–1.23 | 0.97 | 0.54–1.77 | 0.96 | 0.50–1.86 | 0.671 | 1.04 | 0.84–1.28 |
+ DDS | 1.00 | 0.79 | 0.54–1.16 | 0.74 | 0.49–1.12 | 0.85 | 0.47–1.56 | 0.80 | 0.41–1.55 | 0.481 | 0.98 | 0.79–1.21 |
+ DQI-I variety | 1.00 | 0.75 | 0.51–1.10 | 0.70 | 0.46–1.06 | 0.78 | 0.42–1.44 | 0.71 | 0.36–1.40 | 0.383 | 0.95 | 0.76–1.19 |
Rice, pasta, meat and fish pattern | ||||||||||||
Diabetes/controls | 107/690 | 90/690 | 62/691 | 58/690 | 42/690 | |||||||
Adjusted model | 1.00 | 0.92 | 0.67–1.27 | 0.64 | 0.44–0.91 | 0.67 | 0.46–0.98 | 0.59 | 0.38–0.91 | 0.014 | 0.82 | 0.71–0.95 |
+ FVS | 1.00 | 0.97 | 0.70–1.35 | 0.70 | 0.48–1.02 | 0.77 | 0.51–1.17 | 0.71 | 0.43–1.16 | 0.208 | 0.89 | 0.75–1.06 |
+ DDS | 1.00 | 0.91 | 0.66–1.25 | 0.61 | 0.43–0.88 | 0.64 | 0.43–0.93 | 0.55 | 0.35–0.85 | 0.005 | 0.80 | 0.68–0.93 |
+ DQI-I variety | 1.00 | 0.81 | 0.59–1.13 | 0.54 | 0.37–0.77 | 0.51 | 0.34–0.76 | 0.42 | 0.25–0.69 | 0.012 | 0.81 | 0.68–0.97 |
Roots, tubers and plantain pattern | ||||||||||||
Diabetes/controls | 83/690 | 93/690 | 71/691 | 62/690 | 50/690 | |||||||
Adjusted model | 1.00 | 1.25 | 0.89–1.76 | 1.01 | 0.70–1.46 | 1.05 | 0.71–1.56 | 1.15 | 0.73–1.80 | 0.944 | 1.06 | 0.90–1.24 |
+ FVS | 1.00 | 1.29 | 0.92–1.82 | 1.09 | 0.75–1.58 | 1.18 | 0.79–1.77 | 1.27 | 0.80–1.99 | 0.631 | 1.10 | 0.94–1.29 |
+ DDS | 1.00 | 1.24 | 0.88–1.75 | 0.99 | 0.68–1.43 | 1.01 | 0.67–1.52 | 1.11 | 0.70–1.75 | 0.927 | 1.04 | 0.89–1.23 |
+ DQI-I variety | 1.00 | 1.29 | 0.92–1.81 | 1.00 | 0.68–1.47 | 1.07 | 0.70–1.63 | 1.13 | 0.70–1.83 | 0.865 | 1.02 | 0.86–1.21 |