Carbohydrate-dense snacks are a key feature of the nutrition transition among Ghanaian adults – findings from the RODAM study

  • Frauke Assmus German Institute of Human Nutrition Potsdam-Rehbruecke
  • Cecilia Galbete German Institute of Human Nutrition Potsdam-Rehbruecke
  • Sven Knueppel German Institute of Human Nutrition Potsdam-Rehbruecke
  • Matthias B. Schulze German Institute of Human Nutrition Potsdam-Rehbruecke
  • Erik Beune Academic Medical Center - University of Amsterdam, Amsterdam Public Health Research Institute
  • Karlijn Meeks Academic Medical Center - University of Amsterdam, Amsterdam Public Health Research Institute
  • Mary Nicolaou Academic Medical Center - University of Amsterdam, Amsterdam Public Health Research Institute
  • Stephen Amoah Institute of Tropical Medicine and International Health, Charité - Universitaetsmedizin Berlin
  • Charles Agyemang Academic Medical Center - University of Amsterdam, Amsterdam Public Health Research Institute
  • Kerstin Klipstein-Grobusch Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
  • Silver Bahendeka Mother Kevin Postgraduate Medical School (MKPMS), Uganda Martyrs University
  • Joachim Spranger Department of Endocrinology and Metabolism, DZHK (German Center for Cardiovascular Research) partner site Berlin, Center for Cardiovascular Research (CCR), Charité –Universitaetsmedizin Berlin
  • Frank P. Mockenhaupt Institute of Tropical Medicine and International Health, Charité - Universitaetsmedizin Berlin
  • Liam Smeeth Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
  • Karien Stronks Academic Medical Center - University of Amsterdam, Amsterdam Public Health Research Institute
  • Ina Danquah Heidelberg Institute of Global Health, Universitaetsklinikum Heidelberg and German Institute of Human Nutrition Potsdam-Rehbruecke
Keywords: eating patterns, meal, snack, nutrition transition, sub-Saharan Africa, migrants

Abstract

Background: African populations in sub-Saharan Africa and African migrants in Europe are facing a rapid upsurge in obesity. This trend has been related to urbanization, migration and associated shifts in lifestyle, including dietary habits. Whether changes in eating patterns contribute to the rising burden of obesity among African populations is currently unknown.

Objective: Our aims in conducting this study were to characterize eating patterns among Ghanaian adults living in their country of origin and in Europe and to explore associations of meal patterns with body mass index (BMI).

Design: Within the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study, data of single 24-h dietary recalls from Ghanaian adults in rural Ghana (n = 20), urban Ghana (n = 42), and Europe (n = 172) were recorded. Eating frequencies, energy intake, and macronutrient composition of eating occasions (EOs, i.e. meals or snacks) were compared between study sites based on descriptive statistics and χ2-/Kruskal–Wallis tests.

Results: A rising gradient of EO frequencies from rural Ghana through urban Ghana to Europe was observed, mainly reflecting the differences in snacking frequencies (≥1 snack per day: 20 vs. 48 vs. 52%, P = 0.008). Meal frequencies were similar across study sites (≥3 meals per day: 30 vs. 33 vs. 38%, P = 0.80). Meals were rich in carbohydrates (median 54.5, interquartile range (IQR): 43.2–64.0 energy%) and total fats (median: 27.0, IQR: 19.9–34.4 energy %); their protein content was lowest in rural Ghana, followed by urban Ghana and Europe (P = 0.0005). Snacks mainly contained carbohydrates (median: 75.7, IQR: 61.0–89.2 energy%). In linear regression analyses, there was a non-significant trend for an inverse association between snacking frequencies and BMI.

Discussion and conclusions: The observed integration of carbohydrate-dense snacks into the diet supports the growing evidence for a nutrition transition among African populations undergoing socioeconomic development. This analysis constitutes a starting point to further investigate the nutritional implications of increased snacking frequencies on obesity and metabolic health in these African populations.

Downloads

Download data is not yet available.

References


  1. Ford ND, Patel SA, Narayan KM. Obesity in low- and middle-income countries: burden, drivers, and emerging challenges. Ann Rev Public Health 2017; 38: 145–64. doi: 10.1146/annurev-publhealth-031816-044604

  2. Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017; 377(1): 13–27. doi: 10.1056/NEJMoa1614362

  3. Agyemang C, Meeks K, Beune E, Owusu-Dabo E, Mockenhaupt FP, Addo J, et al. Obesity and type 2 diabetes in sub-Saharan Africans – is the burden in today’s Africa similar to African migrants in Europe? The RODAM study. BMC Med 2016; 14(1): 166. doi: 10.1186/s12916-016-0709-0

  4. Obesity and overweight. WHO; 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [cited 1 April 2020]

  5. Adeboye B, Bermano G, Rolland C. Obesity and its health impact in Africa: a systematic review. Cardiovasc J Afr 2012; 23(9): 512–21. doi: 10.5830/cvja-2012-040

  6. Agyemang C., Boatemaa S., Frempong G.A., de-Graft Aikins A. (2015) Obesity in Sub-Saharan Africa. In: Ahima R. (eds) Metabolic Syndrome. Springer, Cham. doi: 10.1007/978-3-319-12125-3_5-1

  7. Kengne AP, Bentham J, Zhou B, Peer N, Matsha TE, Bixby H, et al. Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int J Epidemiol 2017; 46(5): 1421–32. doi: 10.1093/ije/dyx078

  8. Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017. Lancet Glob Health 2019; 7(10): e1375–e87. doi: 10.1016/s2214-109x(19)30374-2

  9. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet (London, England) 2009; 373(9669): 1083–96. doi: 10.1016/s0140-6736(09)60318-4

  10. Schwingshackl L, Hoffmann G. Diet quality as assessed by the healthy eating index, the alternate healthy eating index, the dietary approaches to stop hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies. J Acad Nutr Diet 2015; 115(5): 780–800.e5. doi: 10.1016/j.jand.2014.12.009

  11. International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: 2019. Available at: https://www.diabetesatlas.org

  12. Meeks KA, Freitas-Da-Silva D, Adeyemo A, Beune EJ, Modesti PA, Stronks K, et al. Disparities in type 2 diabetes prevalence among ethnic minority groups resident in Europe: a systematic review and meta-analysis. Int Emerg Med 2016; 11(3): 327–40. doi: 10.1007/s11739-015-1302-9

  13. Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet (London, England) 2010; 375(9733): 2254–66. doi: 10.1016/s0140-6736(10)60550-8

  14. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012; 70(1): 3–21. doi: 10.1111/j.1753-4887.2011.00456.x

  15. Galbete C, Nicolaou M, Meeks KA, de-Graft Aikins A, Addo J, Amoah SK, et al. Food consumption, nutrient intake, and dietary patterns in Ghanaian migrants in Europe and their compatriots in Ghana. Food Nutr Research 2017; 61(1): 1341809. doi: 10.1080/16546628.2017.1341809

  16. Popkin BM, Lu B, Zhai F. Understanding the nutrition transition: measuring rapid dietary changes in transitional countries. Public Health Nutr 2002; 5(6a): 947–53. doi: 10.1079/phn2002370

  17. Duffey KJ, Pereira RA, Popkin BM. Prevalence and energy intake from snacking in Brazil: analysis of the first nationwide individual survey. Eur J Clin Nutr 2013; 67(8): 868–74. doi: 10.1038/ejcn.2013.60

  18. Wang Z, Zhai F, Zhang B, Popkin BM. Trends in Chinese snacking behaviors and patterns and the social-demographic role between 1991 and 2009. Asia Pac J Clin Nutr 2012; 21(2): 253–62.

  19. Popkin BM. Contemporary nutritional transition: determinants of diet and its impact on body composition. Proc Nutr Soc 2011; 70(1): 82–91. doi: 10.1017/s0029665110003903

  20. Saleh A, Amanatidis S, Samman S. Cross-sectional study of diet and risk factors for metabolic diseases in a Ghanaian population in Sydney, Australia. Asia Pac J Clin Nutr 2002; 11(3): 210–16. doi: 10.1046/j.1440-6047.2002.00293.x

  21. Burns C. Effect of migration on food habits or Somali women living as refugees in Australia. Ecol Food Nutr 2004; 43(3): 213–29. doi: 10.1080/03670240490447541

  22. Gibson R, Knight A, Asante M, Thomas J, Goff LM. Comparing dietary macronutrient composition and food sources between native and diasporic Ghanaian adults. Food Nutr Res 2015; 59: 27790. doi: 10.3402/fnr.v59.27790

  23. Osei-Kwasi HA, Powell K, Nicolaou M, Holdsworth M. The influence of migration on dietary practices of Ghanaians living in the United Kingdom: a qualitative study. Ann Hum Biol 2017; 44(5): 454–63. doi: 10.1080/03014460.2017.1333148

  24. Tuomainen HM. Ethnic identity, (post)colonialism and foodways. Food Cult Soc 2009; 12(4): 525–54. doi: 10.2752/175174409X456773

  25. Asante M, Pufulete M, Thomas J, Wiredu E, Intiful F. Food consumption pattern of Ghanaians living in Accra and London. Int J Curr Res 2015; 7: 16216–23.

  26. Tuomainen H. Migration and foodways: continuity and change among Ghanaians in London. PhD thesis, University of Warwick, 2006.

  27. Danquah I, Galbete C, Meeks K, Nicolaou M, Klipstein-Grobusch K, Addo J, et al. Food variety, dietary diversity, and type 2 diabetes in a multi-center cross-sectional study among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study. Eur J Nutr 2018; 57(8): 2723–33. doi: 10.1007/s00394-017-1538-4

  28. Osei-Kwasi HA, Boateng D, Danquah I, Holdsworth M, Mejean C, Terragni L, et al. Acculturation and food intake among Ghanaian migrants in Europe: findings from the RODAM study. J Nutr Educ Behav 2020; 52(2): 114–25. doi: 10.1016/j.jneb.2019.09.004

  29. Leech RM, Worsley A, Timperio A, McNaughton SA. Characterizing eating patterns: a comparison of eating occasion definitions. Am J Clin Nutr 2015; 102(5): 1229–37. doi: 10.3945/ajcn.115.114660

  30. Leech RM, Worsley A, Timperio A, McNaughton SA. Understanding meal patterns: definitions, methodology and impact on nutrient intake and diet quality. Nutr Res Rev 2015; 28: 1–21. doi: 10.1017/S0954422414000262

  31. Wang YQ, Zhang YQ, Zhang F, Zhang YW, Li R, Chen GX. Increased eating frequency is associated with lower obesity risk, but higher energy intake in adults: a meta-analysis. Int J Environ Res Public Health 2016; 13(6): 603. doi: 10.3390/ijerph13060603

  32. McCrory MA, Howarth NC, Roberts SB, Huang TT. Eating frequency and energy regulation in free-living adults consuming self-selected diets. J Nutr 2011; 141(1): 148–53. doi: 10.3945/jn.109.114991

  33. Kant AK. Evidence for efficacy and effectiveness of changes in eating frequency for body weight management. Adv Nutr (Bethesda, Md) 2014; 5(6): 822–8. doi: 10.3945/an.114.007096

  34. Palmer MA, Capra S, Baines SK. Association between eating frequency, weight, and health. Nutr Rev 2009; 67(7): 379–90. doi: 10.1111/j.1753-4887.2009.00204.x

  35. Andersson I, Rössner S. Meal patterns in obese and normal weight men: the ‘Gustaf’ study. Eur J Clin Nutr 1996; 50(10): 639–46.

  36. Johnson GH, Anderson GH. Snacking definitions: impact on interpretation of the literature and dietary recommendations. Crit Rev Food Sci Nutr 2010; 50(9): 848–71. doi: 10.1080/10408390903572479

  37. Agyemang C, Beune E, Meeks K, Owusu-Dabo E, De-Graft Aikins A, Dodoo F, et al. Rationale and cross-sectional study design of the research on obesity and type 2 diabetes among African migrants: the RODAM study. BMJ 2014; 4: 1–9. doi: 10.1136/bmjopen-2014-004877

  38. Hayati Rezvan P, Lee KJ, Simpson JA. The rise of multiple imputation: a review of the reporting and implementation of the method in medical research. BMC Med Res Methodol 2015; 15: 30. doi: 10.1186/s12874-015-0022-1

  39. Conway JM, Ingwersen LA, Vinyard BT, Moshfegh AJ. Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women. Am J Clin Nutr 2003; 77(5): 1171–8. doi: 10.1093/ajcn/77.5.1171

  40. Murakami K, Livingstone MB. Decreasing the number of small eating occasions (<15% of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity: a cross-sectional study in British children and adolescents. Br J Nutr 2016; 115(2): 332–41. doi: 10.1017/s0007114515004420

  41. Ma Y, Bertone ER, Stanek EJ, 3rd, Reed GW, Hebert JR, Cohen NL, et al. Association between eating patterns and obesity in a free-living US adult population. Am J Epidemiol 2003; 158(1): 85–92. doi: 10.1093/aje/kwg117

  42. Bachman JL, Phelan S, Wing RR, Raynor HA. Eating frequency is higher in weight loss maintainers and normal-weight individuals than in overweight individuals. J Am Diet Assoc 2011; 111(11): 1730–4. doi: 10.1016/j.jada.2011.08.006

  43. Gibney MJ, Wolever TM. Periodicity of eating and human health: present perspective and future directions. Br J Nutr 1997; 77(Suppl 1): S3–5. doi: 10.1079/BJN19970099

  44. Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Activ Health 2009; 6(6): 790–804. doi: 10.1123/jpah.6.6.790

  45. Garnweidner LM, Terragni L, Pettersen KS, Mosdøl A. Perceptions of the host country’s food culture among female immigrants from Africa and Asia: aspects relevant for cultural sensitivity in nutrition communication. J Nutr Educ Behav 2012; 44(4): 335–42. doi: 10.1016/j.jneb.2011.08.005

  46. Galbete C, Nicolaou M, Meeks K, Klipstein-Grobusch K, de-Graft Aikins A, Addo J, et al. Dietary patterns and type 2 diabetes among Ghanaian migrants in Europe and their compatriots in Ghana: the RODAM study. Nutr Diabetes 2018; 8(1): 25. doi: 10.1038/s41387-018-0029-x

  47. Frank LK, Kröger J, Schulze MB, Bedu-Addo G, Mockenhaupt FP, Danquah I. Dietary patterns in urban Ghana and risk of type 2 diabetes. Br J Nutr 2014; 112(1): 89–98. doi: 10.1017/s000711451400052x

  48. Nti CA. Household dietary practices and family nutritional status in rural Ghana. Nutr Res Pract 2008; 2(1): 35–40. doi: 10.4162/nrp.2008.2.1.35

  49. Plahar W, Nti C, Quaye W, Nyako P. Household food availability and consumption behaviour in the coastal savanna zone of Ghana. A project report. Accra: Food Research Institute, C.S.I.R.; 1999.

  50. Tuomainen H. Eating alone or together? Commensality among Ghanaians in London. Anthropol Food 2014; 14: S10. doi: 10.4000/aof.7718

  51. Heckert J, Boatemaa S, Altman CE. Migrant youth’s emerging dietary patterns in Haiti: the role of peer social engagement. Public Health Nutr 2015; 18(7): 1262–71. doi: 10.1017/s1368980014001372

  52. Casali ME, Borsari L, Marchesi I, Borella P, Bargellini A. Lifestyle and food habits changes after migration: a focus on immigrant women in Modena (Italy). Ann Ig 2015; 27(5): 748–59. doi: 10.7416/ai.2015.2067

  53. Papadaki A, Scott JA. The impact on eating habits of temporary translocation from a Mediterranean to a Northern European environment. Eur J Clin Nutr 2002; 56(5): 455–61. doi: 10.1038/sj.ejcn.1601337

  54. Parackal S. Dietary transition in the South Asian diaspora: implications for diabetes prevention strategies. Curr Diabetes Rev 2017; 13(5): 482–7. doi: 10.2174/1573399812666160901094741

  55. Koctuerk T. Structure and change in food habits. Scand J Nutr 1995; 39(1): 2–4.

  56. Satia-Abouta J, Patterson RE, Neuhouser ML, Elder J. Dietary acculturation: applications to nutrition research and dietetics. J Am Diet Assoc 2002; 102(8): 1105–18. doi: 10.1016/s0002-8223(02)90247-6

  57. Lawrence JM, Devlin E, Macaskill S, Kelly M, Chinouya M, Raats MM, et al. Factors that affect the food choices made by girls and young women, from minority ethnic groups, living in the UK. J Hum Nutr Diet 2007; 20(4): 311–19. doi: 10.1111/j.1365-277X.2007.00766.x

  58. Gilbert PA, Khokhar S. Changing dietary habits of ethnic groups in Europe and implications for health. Nutr Rev 2008; 66(4): 203–15. doi: 10.1111/j.1753-4887.2008.00025.x

  59. Pietzek T. Ein ghanaischer Mythos: Fett ist gesund und verführerisch! Eine Befragung von in Berlin lebenden Ghanaerinnen und Ghanaern zu ihren Ernährungsgewohnheiten. Master’s thesis, Alice Salomon Hochschule, Berlin, 2012.

  60. Fabry P, Hejl Z, Fodor J, Braun T, Zvolankova K. The frequency of meals. Its relation to overweight, hypercholesterolaemia, and decreased glucose-tolerance. Lancet (London, England) 1964; 2(7360): 614–15. doi: 10.1016/S0140-6736(64)90510-0

  61. Metzner HL, Lamphiear DE, Wheeler NC, Larkin FA. The relationship between frequency of eating and adiposity in adult men and women in the Tecumseh Community Health Study. Am J Clin Nutr 1977; 30(5): 712–15. doi: 10.1093/ajcn/30.5.712

  62. Ruidavets JB, Bongard V, Bataille V, Gourdy P, Ferrières J. Eating frequency and body fatness in middle-aged men. Int J Obes Relat Metab Disord 2002; 26(11): 1476–83. doi: 10.1038/sj.ijo.0802143

  63. Edelstein SL, Barrett-Connor EL, Wingard DL, Cohn BA. Increased meal frequency associated with decreased cholesterol concentrations; Rancho Bernardo, CA, 1984–1987. Am J Clin Nutr 1992; 55(3): 664–9. doi: 10.1093/ajcn/55.3.664

  64. Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr 1996; 50(8): 513–19.

  65. Dreon DM, Frey-Hewitt B, Ellsworth N, Williams PT, Terry RB, Wood PD. Dietary fat:carbohydrate ratio and obesity in middle-aged men. Am J Clin Nutr 1988; 47(6): 995–1000. doi: 10.1093/ajcn/47.6.995

  66. Kirk TR. Role of dietary carbohydrate and frequent eating in body-weight control. Proc Nutr Soc 2000; 59(3): 349–58. doi: 10.1017/s0029665100000409

  67. Leidy HJ, Armstrong CL, Tang M, Mattes RD, Campbell WW. The influence of higher protein intake and greater eating frequency on appetite control in overweight and obese men. Obesity (Silver Spring, Md) 2010; 18(9): 1725–32. doi: 10.1038/oby.2010.45

  68. Jenkins DJ, Jenkins AL, Wolever TM, Vuksan V, Rao AV, Thompson LU, et al. Low glycemic index: lente carbohydrates and physiological effects of altered food frequency. Am J Clin Nutr 1994; 59(3 Suppl): 706s–9s. doi: 10.1093/ajcn/59.3.706S

  69. Speechly DP, Buffenstein R. Greater appetite control associated with an increased frequency of eating in lean males. Appetite 1999; 33(3): 285–97. doi: 10.1006/appe.1999.0265

  70. Duval K, Strychar I, Cyr MJ, Prud’homme D, Rabasa-Lhoret R, Doucet E. Physical activity is a confounding factor of the relation between eating frequency and body composition. Am J Clin Nutr 2008; 88(5): 1200–5. doi: 10.3945/ajcn.2008.26220

Published
2021-05-06
How to Cite
Assmus, F., Galbete, C., Knueppel, S., Schulze, M. B., Beune, E., Meeks, K., Nicolaou, M., Amoah, S., Agyemang, C., Klipstein-Grobusch, K., Bahendeka, S., Spranger, J., Mockenhaupt, F. P., Smeeth, L., Stronks, K., & Danquah, I. (2021). Carbohydrate-dense snacks are a key feature of the nutrition transition among Ghanaian adults – findings from the RODAM study. Food & Nutrition Research, 65. https://doi.org/10.29219/fnr.v65.5435
Section
Original Articles