Abstract
We collected dietary records over the course of nine months to comprehensively characterize the consumption patterns of Malagasy people living in remote rainforest areas of north-eastern Madagascar. The present study was a prospective longitudinal cohort study to estimate dietary diversity and nutrient intake for a suite of macronutrients, micronutrients and vitamins for 152 randomly selected households in two communities. Madagascar, with over 25 million people living in an area the size of France, faces a multitude of nutritional challenges. Micronutrient-poor staples, especially rice, roots and tubers, comprise nearly 80 % of the Malagasy diet by weight. The remaining dietary components (including wild foods and animal-source foods) are critical for nutrition. We focus our study in north-eastern Madagascar, characterized by access to rainforest, rice paddies and local agriculture. We enrolled men, women and children of both sexes and all ages in a randomized sample of households in two communities. Although the Household Dietary Diversity Score and Food Consumption Score reflect high dietary diversity, the Minimum Dietary Diversity-Women indicator suggests poor micronutrient adequacy. The food intake data confirm a mixed nutritional picture. We found that the median individual consumed less than 50 % of his/her age/sex-specific Estimated Average Requirement (EAR) for vitamins A, B12, D and E, and Ca, and less than 100 % of his/her EAR for energy, riboflavin, folate and Na. Malnutrition in remote communities of north-eastern Madagascar is pervasive and multidimensional, indicating an urgent need for comprehensive public health and development interventions focused on providing nutritional security.
Highlights
We focus on Estimated Average Requirement (EAR) in the current analysis because they are appropriate for international nutritional assessment[19]
Combining the weight of all cereals and roots and tubers, 77·3 % of all food by weight consumed in the household came from micronutrient-poor starches (Supplemental Table S4), amounting to 78·9 % of total energy
There was a consistent deficit in energy throughout the year, largely attributable to inadequate fat intake linked to insufficient access to animal-source foods or other sources of fats such as cooking oil
Summary
Nutrient intake We found total mass of food consumption to be relatively low, with individuals receiving a mean of only 5966 kJ (1426 kcal; 958 g) of prepared food each day, or 7770 kJ (1857 kcal; 1247 g) per adult male equivalent (Fig. 2). Combining the weight of all cereals (rice, bread, pasta, flour) and roots and tubers (cassava, yam, taro, sweet potato, etc.), 77·3 % of all food by weight consumed in the household came from micronutrient-poor starches (Supplemental Table S4), amounting to 78·9 % of total energy.
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