Department of Nutrition and Dietetics
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Item Nutritional Anaemia in Pregnant Adolescent Girls in Selected Communities in the Greater Accra Region(University Of Ghana, 2018-07) Hogrey, F.D.Background Nutritional anaemia in pregnancy still remains a problem of public health concern particularly in developing countries such as Ghana. The period of adolescence and pregnancy are both critical periods that place the individual at risk of developing nutrient deficiencies because of the rapid and increased demands in nutrients. Failure to meet the nutritional demands can affect the growth of the adolescent mother and that of the developing baby. Literature gaps exist in the micronutrient (iron, folate and vitamin B12) status, quality of diets, as well as dietary practices, myths and misconceptions of nutritional anaemia among pregnant adolescent girls in Ghana. Aim To determine the prevalence of nutritional anaemia, quality of the diet and to assess the myths and misconceptions concerning nutrition of pregnant adolescent girls in three communities in the Greater Accra Region. Methods A mixed method design (cross sectional and qualitative focus group discussions) was employed. The cross sectional component recruited pregnant adolescent girls (N=265) between the ages of 15-19 years from 3 hospitals in the Greater Accra Region. Dietary intake data were obtained based on a 3-day 24 hour dietary recall and a food frequency questionnaire. Minimum Dietary Diversity for women of reproductive ages (MDD-W) was determined based on FAO guidelines (FAO & FHI360, 2016). . Serum concentrations of iron, folate and vitamin B12 were determined using VITROS Chemistry Fe Slides method, ID-Vit® ELISA Folate and ID-Vit® ELISA Vitamin B12 test kits respectively. Serum TIBC and ferritin were also determined with VITROS Chemistry products Total Iron Binding Capacity (TIBC) kit and AccuBind ELISA microwells respectively. Four (4) focus group discussions were held to obtain information on nutrition knowledge, myths and misconceptions and sources of information on nutritional anaemia. Differences between means were tested using independent t-tests and ANOVA. Z-tests were used to test for differences between proportions. Logistic regressions were employed in determining the odds of being anaemic and the odds of obtaining good dietary diversity. Thematic approach of analysis was employed in analysing the qualitative data. Results Two hundred and six five (265) and twenty four (24) pregnant adolescents were involved in the cross sectional and qualitative studies respectively. Their mean age was 17.88 (SD = 1.08) years for the cross sectional study and 17.44 (SD = 1.29) years for the qualitative component. The prevalence of anaemia was 71.6%. Deficiencies in iron, folate and vitamin B12 were 61.4%, 50.4% and 11.7% respectively. Mean nutrient intakes of iron, folate and vitamin B12 were 9.10 (SD = 4.26; CI 8.54 -9.66) mg, 110.90 (SD = 56.36; CI 103.46-118.34) μg and 1.61 (SD = 1.26; CI 1.44-1.78) μg respectively. Proportion of girls with adequate intakes of iron (1.3%); and vitamin B12 (22.5%)) were significantly low (p < 0.001). None of the pregnant girls had adequate intake of folate. Prevalence of good MDD-W was 24.6% and average MDD-W score was 3.85 (SD = 0.95). The significant predictor of MDD-W was dietary folate (p = 0.010). The significant predictors of anaemia were dietary vitamin B12 (p = 0.022) and dietary iron (p = 0.039). Turkey berries (Solanum torvum), milk and malt drinks were regarded as foods that promote blood formation. The pregnant girls mentioned inadequate food intakes, drinking a lot of water, paradoxically not drinking a lot of water and exposure to sunlight as the main causes of anaemia.Item The Effectiveness of Dietary and Lifestyle Intervention in Persons with Major Lifestyle Related Chronic Diseases at the Korle-Bu Teaching Hospital(University Of Ghana, 2018-07) Steele-Dadzie, R.K.Background: The global prevalence of chronic non-communicable diseases (NCDs) continues to rise, accounting for over 71% of all global death and responsible for over 40% of pre-mature death (death occurring before the age 70 years). Low and middle income countries (LMIC) are expected to suffer the brunt of this epidemic, leading to high rates of disease, death and disability adjusted live years (DALYs). Most NCD’s and their shared risk factors are preventable through lifestyle modifications, mainly regular physical activity, consumption of healthy diet, cessation of smoking and moderate use of alcohol. The main lifestyle indicator for the prevention of NCD’s, however, is intake of healthy diet with emphasis on the regular intake of whole grains, fruits and vegetables, fish, nuts and seeds, low-fat dairy products, low saturated and trans-fat and high mono and polyunsaturated fat. Dietitians are the health care professionals specially trained to apply nutritional science in providing evidence based dietary intervention to prevent and manage various NCDs mainly through counselling. The dietetics profession and practice is evolving in Ghana, with a number of health care facilities currently resourced with dietitians. Patients are increasingly being referred by physicians to dietitians, to assist in the management of their various conditions. Information on the common conditions that get referred to dietitians in Ghana is, however, scanty. There is also paucity of information regarding patient’s attitude towards such referrals and potential challenges they face in their effort to seek dietetic care. In addition, evidence is lacking on the effectiveness of the dietary intervention patients receive on their measurable health outcomes. These gaps in the practice of Dietherapy in Ghana informed this research. Aim: The study had 2 phases. The primary aim for phase one was to identify the major lifestyle-related chronic diseases referred to the Dietherapy Department of the Korle-Bu Teaching Hospital (KBTH), the major referral tertiary facility in Ghana. The primary aim for phase two was to audit the effectiveness of the routine dietary and lifestyle intervention given to patients at the Dietherapy Department of the KBTH on their dietary habits, alcohol intake, physical activity habits, smoking habits, anthropometry, body composition, blood pressure and biochemical indicators. Method: Phase one was a cross-sectional study. Phase two was a clinical audit which followed a longitudinal study design. The Dietherapy Department of the Korle-Bu Teaching Hospital was the study site for both phases. Eligible participants were newly referred adult patients, referred by a medical doctor, who consented to participate. Nutrient and usual dietary intake were assessed using 24-hour dietary recall interviews for 2 days (1 weekday and 1 weekend) and a validated Food Frequency Questionnaire (FFQ) respectively. Anthropometry (height and weight for BMI, waist and hip circumference for waist-hip circumference ratio), body composition (percentage body fat, visceral fat, skeletal muscle, total body water) and blood pressure were measured. Biochemical indices (serum total cholesterol, low density lipoprotein cholesterol (LDLc), high density lipoprotein cholesterol (HDLc), triglycerides, C-reactive protein, fasting plasma glucose and 2-hour plasma glucose) were determined. All measurements were done at baseline and repeated at 3 and 6 months follow-up. Dietary and lifestyle intervention were based on the department’s protocols developed from international guidelines for chronic disease management, especially National Cholesterol Education Programme and International Diabetes Federation, as well as the dietary approach to stop hypertension (DASH) and Mediterranean diets. All patients were counselled at baseline and reiterated at reviews. Statistical package for social sciences (SPSS) version 20 was used to analyze the data at a 95% confidence interval. Descriptive statistics (means, median, standard deviation, ranges) were used to summarize continuous variables such as anthropometric indices and blood pressure. Chi square was used to analyze categorical data. Differences between means at baseline and follow-up were determined using analysis of variance (ANOVA) for repeated measures and independent sample t-test. Multiple linear and logistic regression analysis were done to determine the predictors of the variability of variables that significantly changed in the course of the study. Results: A total of 339 patients participated in the cross-sectional study. A sub-sample of 132 were followed up for 6 months with 60 patients completing at 6 months. Hypertension (48.1%), was the major diet related chronic condition referred to the Dietherapy Department. It was followed by diabetes (44.8%), dyslipidemia (38.1%) and obesity (24.8%). Half (50.1%) of patients who were referred delayed in assessing dietary care mainly because the Department had closed when they got there on the same day of referral. Alcohol intake, smoking and physical activity levels of patients were all generally low at baseline and did not change markedly after 6 months. The proportion of patients who engaged in moderate physical activity, however, increased significantly at 6 months (61.7%; P < 0.001) compared to baseline (30.3%). Patients’ body mass index (BMI) and educational level predicted 13% of the variability in physical activity habits. Normal weight and overweight patients had 55% (p = 0.172, CI: 0.235- 1.296) and 40% (p = 0.015, CI: 0.194 – 0.840) odds of not engaging in physical activity respectively, compared to obese patients. The odds of patients with no formal education, primary education or secondary education not engaging in moderate physical activity was 19 (p < 0.001, CI: 3.686 – 99.604), 3 (p = 0.009, CI: 1.316 – 6.924) and 2 (p = 0.358, CI: 0.629 – 3.608) times that of those with tertiary education respectively. Carbohydrate and dietary fibre intake increased significantly (p = 0.010, p = 0.025) respectively, between baseline and 6 months. This was attributed to the addition of whole grains and fruits to the usual diets of patients. Daily intake of total fat, protein and sodium decreased by 6 months but were not statistically significant (p = 0.195, p = 0.132, p = 0.430) respectively. Total daily energy intake did not change significantly throughout the study (p = 0.344). Body mass index and visceral fat decreased significantly (p < 0.001, p = 0.005) respectively, between baseline and 3 months. The decreases were sustained at 6 months (p = 0.001, p = 0.003) respectively. Systolic and diastolic blood pressure remained unchanged despite pharmacological treatment and lifestyle modification (137 ± 26 mmHg; p = 0.867) and (88 ± 15 mmHg; p = 0.925) respectively. Fasting plasma glucose (FPG) significantly decreased (p = 0.044) between baseline and 3 months and was sustained at 6 months (p = 0.001). Two-hour glucose also significantly decreased at 6 months (p = 0.001). Both fasting and 2-hour glucose were predicted by waist-hip circumference ratio. High density lipoprotein (HDL) cholesterol increased significantly at 6 months (p = 0.045). The variability in HDL was explained by patients’ percentage body fat, LDLc, triglyceride and serum total cholesterol in a multiple linear regression model. Conclusion: The commonest NCDs seen at the Dietherapy Department were hypertension followed by diabetes mellitus, dyslipidaemia and obesity in decreasing order. Routine dietary and lifestyle intervention given to patients with NCDs at the Dietherapy Department of the KBTH led to improvement in a significant number of the measurable outcomes. These improvements have the potential to reduce their related complications if maintained on the long term. Physicians must therefore be encouraged to refer more patients for dietetic care.Item Diet and Levels of Two Endogenous Antioxidants, Superoxide Dismutase and Catalase, In the Blood of Seventh - day Adventist Vegetarians And Non-Vegetarians In Mayera And Dansoman In The Greater Accra Region of Ghana(University of Ghana, 2015-06) Ofori-Amanfo, B.; Asante, M.; Asare, G.; University of Ghana,College of Health Sciences, School of Biomedical and Allied Health Sciences, Department of Nutrition and DieteticsVegetarianism is a dietary lifestyle that involves the restriction of diet, disallowing some or all foods of animal origin, thereby consuming mainly foods of plant origin. Vegetarian diets are composed of only plant products which include fruits and vegetables, as well as grains, legumes, nuts and seeds. The plant products they consume are rich sources of vitamins such as Vitamins A, C and E which act directly as antioxidants, as well as protein and minerals such as zinc, iron, magnesium and selenium, which function as co-factors for antioxidant enzymes, synthesized in the body. Free radicals cause cell damage and have been found to be an important contributory factor in the occurrence of diseases such as brain dysfunction, cancer, cardiovascular diseases. Little data exists on dietary composition and serum levels of endogenous antioxidants of vegetarians in Ghana. Objectives: The aim of the study was to compare the diet and serum and plasma levels of two common intracellular antioxidants in Seventh - day Adventist vegetarians and non-vegetarians in Mayera and Dansoman, in the Greater Accra region of Ghana. Methodology: A case – control study was carried out involving 39 vegetarians and 30 non-vegetarians. Blood pressure and anthropometric measurement (weight, height, visceral fat and body fat) was measured for all the participants. A structured questionnaire was used to obtain socio- demographic data of the participants. Dietary intake was assessed using a 24-hour recall and food frequency questionnaire. Venous blood samples were collected to assess serum and plasma levels of the endogenous antioxidants, catalase and superoxide dismutase.Item Effect of Different Vegetable Fats on Lipid Profile and Risk of Atherosclerosis in Rats(University of Ghana, 2013-07) Ainuson, J.K.; Amoah, A.G.B.; Wiredu, E.E.K.; Asare, G.A.; Addo, P.Atherosclerotic vascular diseases (AVDs) are presently increasing rapidly in incidence and have become key contributors to the burden of disease in most developing countries like Ghana. The condition has been projected to more than double by 2025. The type and amount of dietary fat has been associated with several disorders including AVDs and it complications. Diet, as one of the most important modifiable risk factors of Coronary Heart Disease (CHD) modulates the other known risk factors. Excessive intake of dietary saturated fat and cholesterol has been found to increase serum cholesterol, thus leading to a high risk of cardiovascular diseases. Saturated fats, both of animal and vegetable or plant origin, have been discredited. This study was carried out to investigate the effect of vegetable fats including olive oil (OO), red palm oil (RdPO) and refined palm oil or palm olein (RfPO) on lipid profile and risk of Atherosclerosis in rat model. Three months old male Sprague-Dawley (S-D) rats (n=56) were divided into four groups: control, olive, red palm and refined palm oil groups (n=14 per group) received water and feed ad libitum. The controls were fed the standard rat chow whilst the treatment (oil) groups received diet enriched with extra 6% by weight of the corresponding oil. During the 16 weeks of dietary intervention, 7 rats were randomly selected from each group and sacrificed at two months intervals, and blood samples collected for biochemical analysis. Plasma lipid profile comprising of Total Cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), Apolipoprotein-A1 (Apo-A1), and Apolipoprotein-B100 (Apo-B100) were determined at baseline and at the end of every two months by the enzymatic technique using the Enzyme-Linked Immuno Sorbant Assay (ELISA). Pro- inflammatory markers including Interleukin-2 (IL-2), Interleukin-6 (IL-6), Tumor Necrosis Factor Alpha (TNF-α) and Total Antioxidant Status (TAS) were also determined by the ELISA method at baseline and at 2 and 4 months. There was no significant difference in the lipid profile of the treatment rats compared to the controls. However, there was a significant effect of the intake of the different oils on the inflammatory markers TNF-α and IL-6. There were also significant differences in the TAS of the rats from the different groups at month 2. Olive oil diet caused a significant decrease in the TNF-α and IL-6 mean concentrations (p=0.008) and (0.0041) respectively and an increase in the TAS mean concentrations (p=0.005). The two palm oil diets (RdPO and RfPO) caused an increase in both TNF-α and IL-6 concentrations. The red palm oil diet resulted in an increase in the TAS, whilst the refined palm oil diet caused a decrease in the TAS. However these effects were not statistically significant. The results suggest that the 3 different oils had different effects on the parameters investigated in this study. The increase in levels of the inflammatory indicators and reduction in total antioxidants levels recorded among rats fed RfPO enriched diet shows a likelihood of the oil enhancing inflammation and leading to oxidative stress and subsequent oxidative damage respectively, hence may have a potential of increasing the risk of development of atherosclerosis in rats. The intake of the red palm oil diet, although to some extent improved TAS of the rats, yet was associated with increased inflammation (TNF-α and IL-6). Therefore prolonged use may probably be associated with increased risk of developing atherosclerosis and other inflammatory diseases. On the contrary, intake of olive oil as a major source of fat may reduce the risk of atherosclerotic development due to its association with significant increase in TAS and a decrease in both IL-6 and TNF- α production in rats. The above findings therefore suggest that, olive oil may be most protective against atherosclerosis compared to the other oils. Also the red palm oil though unrefined, turned out to have a better antioxidant capacity than the refined form.Item The Development of a Photographic Food Atlas with Portion Sizes of Commonly Consumed Carbohydrate Foods in Accra, Ghana(University of Ghana, 2014-07) Boateng, G.P.; Asiedu, M.S.; Asante, M.; Salia, F.K.Background: The photographic food atlas, a portion size measurement aid has been used to estimate, quantify, educate and counsel on appropriate food portions to help improve dietary intake, and achieve a healthy change. Consumption of larger portion sizes is associated with increases in non-communicable diseases (NCDs), however; most people do not know what makes up a portion. NCDs are on the increase in Ghana. A photographic food atlas with portions sizes of commonly consumed foods in Ghana is needed to help educate and improve on portion sizes in order to control the increase risk of NCDs in Ghana. Aim: The aim of this study was to identify commonly consumed carbohydrate based foods in Accra, Ghana, and to produce and validate a photographic food atlas with portion sizes based on gender, age and BMI. Method: A three phased cross-sectional study was employed. This consisted of identifying, collating and categorizing commonly consumed and most commonly consumed carbohydrate foods (phase 1), developing a photographic food atlas based on data collected (phase 2) and estimating randomly selected cooked portions of most commonly consumed carbohydrate foods from the developed photographic food atlas in a pilot and a major part (phase 3). The study involved eight hundred and eight (808) participants in the first phase, fifty (50) males and females of equal distribution in the pilot and two hundred and eighty (280) participants in the major phase. The study took place in three hundred and eighty four (384) conveniently selected households from thirty (30) randomly selected suburbs in the five (5) metropolitan areas of the four (4) income zones in the Greater Accra Region. Socio-demographic information, carbohydrate consumption, recipe collation for the first phase of the study were obtained through pretested questionnaires, three day food diaries, recipe booklets, a recipe book and on-line recipes. The commonly consumed carbohydrate foods identified were cooked in portions of between one (1) and eight (8), weighed, plated, coded, coloured photographed, cropped, captured on A-4 sheets and ring bound into a photo album. The most commonly consumed foods identified from the commonly consumed carbohydrate foods were captured in photo series. Results: Ninety one (91) common carbohydrate foods made up of 70.3% grain and cereal group, 24.2% roots, tubers and plantain group and 5.5% of beverage and sugar group were collated. The developed photographic food atlas contained twenty four (24) foods in single portions, four (4) in portions of two (2) and sixty two (62) foods in portions of eight (8). Six thousand seven hundred and twenty (6720) estimations were made. Overall, a significantly higher proportion of participants (54.17%; (P=0.03) were able to make correct estimation of portion sizes using the food atlas. On the whole gender (P=0.001) and age (P=0.018) were positively linked to estimations with a higher proportion of females (54.48%) and participants within 55-64 age range (58.13%) better at estimation. The ability of males to correctly estimate portion sizes was affected by age (P=0.024). Being of a body mass indexes (BMI) of >30 kg/m2 was statistically linked to overestimation (P=0.027). However as a group, BMI had no statistical significance on portion size estimation. Conclusion: Generally, participants were able to estimate portion sizes correctly. Estimation was significantly affected by age and gender. However, females were better able to estimate portion sizes than males. The results from this study suggest that the developed photographic food atlas can be used to assess portions of commonly consumed carbohydrate foods in Ghana.