A Food Photograph Series for Identifying Portion Sizes of Culturally Specific Dishes in Rural Areas with High Incidence of Oesophageal Cancer

Martani Lombard,Hester-Mari Burger,Marjanne Senekal,Nelia Steyn,Karen Charlton

doi:10.3390/nu5083118

Abstract

Rural areas of the Eastern Cape (EC) Province, South Africa have a high incidence of squamous cell oesophageal cancer (OC) and exposure to mycotoxin fumonisin has been associated with increased OC risk. However, to assess exposure to fumonisin in Xhosas—having maize as a staple food—it is necessary to determine the amount of maize consumed per day. A maize-specific food frequency questionnaire (M-FFQ) has recently been developed. This study developed a food photograph (FP) series to improve portion size estimation of maize dishes. Two sets of photographs were developed to be used alongside the validated M-FFQ. The photographs were designed to assist quantification of intakes (portion size photographs) and to facilitate estimation of maize amounts in various combined dishes (ratio photographs) using data from 24 h recalls (n = 159), dishing-up sessions (n = 35), focus group discussions (FGD) (n = 56) and published literature. Five villages in two rural isiXhosa-speaking areas of the EC Province, known to have a high incidence of OC, were randomly selected. Women between the ages of 18–55 years were recruited by snowball sampling and invited to participate. The FP series comprised three portion size photographs (S, M, L) of 21 maize dishes and three ratio photographs of nine combined maize-based dishes. A culturally specific FP series was designed to improve portion size estimation when reporting dietary intake using a newly developed M-FFQ.

Highlights

A relatively small geographic area in rural areas of the Eastern Cape (EC) Province of South Africa has a high incidence of squamous cell oesophageal cancer (OC) [1]
EC Province; (ii) women from the study area dishing up their ―usual‖ serving portions and (iii) data on portion sizes obtained from a national database
This was done by reviewing published data and data from a study using 24 h recalls from the EC Province

Summary

Introduction

A relatively small geographic area in rural areas of the Eastern Cape (EC) Province of South Africa has a high incidence of squamous cell oesophageal cancer (OC) [1]. Maize is the primary staple food of the black population of South Africa and is consumed in large amounts on a daily basis in the geographical area of interest [3,4]. Fumonisin contamination of this food source is a major health concern and to date no quantitative assessment of exposure has been conducted [6]. A culturally specific maize-specific food frequency questionnaire (M-FFQ) was developed [7] to determine fumonisin exposure from maize consumption in rural-dwelling residents of the EC Province. Influenced the colour of dishes containing spinach. Maize dishes are white and there was little contrast between the food and the plate.

Objectives

Methods

Results

Conclusion