Consuming cassava as a staple food places children 2-5 years old at risk for inadequate protein intake, an observational study in Kenya and Nigeria

Kevin Stephenson,Rachel Amthor,Mark Manary,Rhoda Nungo,Simon Gichuki,Sally Mallowa,Ada Mbanaso,Busie Maziya-Dixon

doi:10.1186/1475-2891-9-9

Abstract

BackgroundInadequate protein intake is known to be deleterious in animals. Using WHO consensus documents for human nutrient requirements, the protein:energy ratio (P:E) of an adequate diet is > 5%. Cassava has a very low protein content. This study tested the hypothesis that Nigerian and Kenyan children consuming cassava as their staple food are at greater risk for inadequate dietary protein intake than those children who consume less cassava.MethodsA 24 hour dietary recall was used to determine the food and nutrient intake of 656 Nigerian and 449 Kenyan children aged 2-5 years residing in areas where cassava is a staple food. Anthropometric measurements were conducted. Diets were scored for diversity using a 12 point score. Pearson's Correlation Coefficients were calculated to relate the fraction of dietary energy obtained from cassava with protein intake, P:E, and dietary diversity.ResultsThe fraction of dietary energy obtained from cassava was > 25% in 35% of Nigerian children and 89% of Kenyan children. The mean dietary diversity score was 4.0 in Nigerian children and 4.5 in Kenyan children, although the mean number of different foods consumed on the survey day in Nigeria was greater than Kenya, 7.0 compared to 4.6. 13% of Nigerian and 53% of Kenyan children surveyed had inadequate protein intake. The fraction of dietary energy derived from cassava was negatively correlated with protein intake, P:E, and dietary diversity. Height-for age z score was directly associated with protein intake and negatively associated with cassava consumption using regression modeling that controlled for energy and zinc intake.ConclusionsInadequate protein intake was found in the diets of Nigerian and Kenyan children consuming cassava as a staple food. Inadequate dietary protein intake is associated with stunting in this population. Interventions to increase protein intake in this vulnerable population should be the focus of future work.

Highlights

Adequate protein intake has been a concern and controversy in international nutrition community for the past 50 years [1,2]
This study tested the hypothesis that Nigerian and Kenyan children consuming cassava as their staple food are at greater risk for inadequate dietary protein intake than those children who consume less cassava
Each state in Nigeria was assigned to an agro-ecological zone; all children surveyed who lived in the humid-forest zone, the area where cassava consumption is greatest, were included in this study

Summary

Introduction

Adequate protein intake has been a concern and controversy in international nutrition community for the past 50 years [1,2]. Protein is often consumed in conjunction with zinc and energy [8]. All of these nutrients are essential for the normal function of almost all cellular and metabolic processes, and deficits in such nutrients have a myriad of generalized clinical effects. While the etiology of these anthropometric abnormalities is multi-factorial, some of these children subsist on diets with inadequate protein intake. Using WHO consensus documents for human nutrient requirements, the protein:energy ratio (P:E) of an adequate diet is > 5%. This study tested the hypothesis that Nigerian and Kenyan children consuming cassava as their staple food are at greater risk for inadequate dietary protein intake than those children who consume less cassava

Methods

Results

Conclusion