Food Consumption Patterns and Dietary Diversity amongst Women of Reproductive Age in Lebanon: A National Study

Abstract

Background: Lebanon faces a triple burden of malnutrition (undernutrition, over nutrition, and micronutrient deficiencies), with women of reproductive age (WRA) being particularly vulnerable. Poor diet quality, specifically a lack of dietary diversity, is a key factor driving nutrient inadequacies among this population. The Minimum Dietary Diversity for Women (MDD-W) has been widely used as a proxy measurement of micronutrient adequacy.

Objectives: This study aims to assess dietary diversity amongst women of reproductive age in Lebanon based on the MDD-W score, investigate its association with nutrient adequacy, and identify the socioeconomic and anthropometric factors associated with high MMD-W in the study sample.

Methods: This study used data pertinent to 15-49 year-old women (n=927) from a national cross-sectional survey conducted in 2012-2013 on a representative sample of Lebanese households. Demographic, socioeconomic, anthropometric and eating pattern characteristics were obtained. Dietary intake was assessed using the single 24-hr recall method. Dietary diversity was calculated based on ten food groups with a cut-off point ≥5 groups indicating higher dietary diversity. To calculate the diversity score for each subject, composite recipes were first disaggregated into their constitutive ingredients and food items that were consumed in quantities ≥15 g on the previous day were considered. Associations between MDD-W and women’s dietary intake (food groups, energy, and select macro- and micronutrients intakes) were examined. Macro- and micronutrient intakes were compared to age- and lactation status specific dietary reference intakes (DRIs), including Acceptable Macronutrient Distribution Range (AMDR), Estimated Average Requirements (EAR), Adequate Intakes (AI) and Upper limits (UL). Simple and multiple logistic regression analysis were used to explore the associations between MDD W and various socioeconomic and anthropometric variables as well as meal patterns. The Statistical Package for the Social Sciences (SPSS; version 27) was used for all computations.

Results: Mean ± SE dietary diversity score was 4.91 ± 0.05 and about 38% of the participants did not meet the MDD-W cut-off. The most commonly consumed food groups included grains (95.4%), followed by meat/poultry/fish (68.5%), vitamin A-rich fruits and vegetables (67.2%) and dairy (64.3%), while, the least consumed food groups were eggs (11.2%) as well as nuts and seeds (12.8%). A higher MDD score was found to be associated with a greater consumption of healthy food groups (e.g. fruits, vegetables, 3 pulses, nuts and seeds and dairy products), and higher intakes of protein, monounsaturated fatty acids (MUFAs), omega-3 (alpha-linolenic acid), and omega-6 (linoleic acid) polyunsaturated fatty acids, as well as dietary fiber. Participants with adequate dietary diversity score (MDD ≥ 5) had significantly higher intakes (/1000 kcal) of all assessed micronutrients (except iodine). In addition, a greater proportion of women with adequate dietary diversity met the DRIs for most of the evaluated macronutrients (except total fat and saturated fat) and micronutrients (except iodine and vitamin D). Based on the simple regression analysis, several factors were significantly associated with dietary diversity, including the household's monthly income, house ownership, the participant's educational status, specialization in a health-related major, daily breakfast consumption, and the number of meals consumed per day. In the multiple logistic regression analysis model, significant associations were retained between the participants' dietary diversity and their daily breakfast consumption as well as the number of meals consumed per day.

Conclusion: The study findings showed that women who achieved the MDD-W reported higher micronutrients intakes and higher consumption of healthy food groups, as well as higher intakes of macronutrients that are linked to improved nutritional status in women. These findings are thus a further validation of the MDD-W and support its use as a proxy indicator for higher micronutrient adequacy in large surveys of WRA living in LMICs, and in the nutrition transition context. Nutritional and public health interventions emphasizing the importance of maximizing dietary diversity and thus, micronutrient adequacy among WRA in Lebanon are needed. These may include interventions that promote healthier meal patterns such as regular breakfast intake and the consumption of at least 3 meals per day. Additional interventions should encourage higher consumption of fruits, vegetables, fish, eggs, pulses, nuts, and seeds to achieve optimal dietary diversity and nutritional adequacy among WRA in Lebanon.