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1000 Asia Pacific J Clin Nutr (1997) 6(4): 251-255

Asia Pacific J Clin Nutr (1997) 6(4): 251-255


Food consumption patterns and nutrient intake among Nepalese living in the southern rural Terai region

Yoshimi Ohno1 PhD, Kazuko Hirai2 PhD, Noriko Sato3 NT, Masashi Ito3 BSc, Teruko Yamamoto4 BSc, Toshihide Tamura5 MD, PhD and Mathura P Shrestha6 MD, PhD

 

1 Department of Food Science and Nutrition, School of Human Environmental Sciences, Mukogawa Women’ s University, Hyogo, Japan,
2 Department of Nutritional Biochemistry, Faculty of Human Life Science, Osaka City University, Osaka, Japan,
3 Japan Overseas Cooperation Volunteers (JOCV), JICA Nepal Office, Kathmandu, Nepal,
4 Department of Food Science and Nutrition, Himeji College of Hyogo, Hyogo, Japan,
5 Department of Bacteriology, Hyogo College of Medicine, Hyogo, Japan and
6 Department of Community Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.


The dietary nutrient intake of persons aged 10-68 years (55 males and 54 females) living in the Chitwan district, Nepal, was investigated using the 24-hour recall method. The mean daily consumption of food for males and females averaged 483 92 and 433 115 g of cereals, 179 126 and 167 126 g of coloured vegetables, 91 177 and 111 206 g of milk and dairy products, 67 91 and 53 82 g of potatoes, respectively. These items constituted more than three-fourths of the total food weight, whereas the amounts and frequency of the consumption of meats, fish and eggs were very low. Males (464 80 g) consumed a larger amount of rice than females (408 105 g, p<0.01). The level of rice consumption 1000 was strongly related to the level of energy intake (r= 0.60), protein (r= 0.44), carbohydrate (r= 0.66), vitamin B1 (r= 0.77), niacin (r= 0.53) and vitamin E (r= 0.54), (p<0.001). The mean amount of total energy intake for males (2340 526 kcal) was higher than that of females (1930 457 kcal, p<0.01). The daily mean intakes of protein, fat, Ca, vitamin B1 and B2 were 51.9 13.0 g, 23.0 9.8 g, 412 228 mg, 1.88 0.33 mg and 0.73 0.27 mg for males and 47.4 12.5 g, 26.1 13.8 g, 395 237 mg, 1.72 0.39 mg and 0.68 0.31 mg for females, respectively. The intake levels of Fe and vitamin E for males (8.5 3.4 and 4.4 1.5 mg) were higher than those of females (6.7 1.9 and 3.7 1.2 mg, p<0.01, respectively). The mean intake of vitamin A, mostly of carotene (about 90% of vitamin A), was 1614 1003 and 1561 1031 IU for males and females, respectively. The consumption of coloured vegetables was correlated with the intake of vitamin A (r= 0.96), B2 (r= 0.37) and C (r= 0.85), (p<0.001, respectively).

Key words: food consumption, nutrient intake, Nepal, Terai region, Chitwan district, Khargual Village, rural, Itahari district, BMI (body mass index), blood pressure


Introduction

Malnutrition is still a public health problem in many developing countries1-3. We have been interested in the nutritional status in Nepal where little survey work has been done. Brown et al4 carried out a dietary survey of 19 villages throughout Nepal in 1965 and reported that the Nepalese diet was generally superior to that reported by FAO for the Far East as a whole.

We have conducted dietary surveys in a mountain area in 19755 and in an industrial region (Itahari district, Terai region) in 19876 to obtain actual data on food consumption of the Nepalese. Although their dietary patterns were found to be very simple and similar, the main cereals consumed in the former case were foxtail millet, Japanese barnyard millet and wheat, whereas in the latter case, much more rice was consumed. Besides cereals, the residents in the Itahari district consumed more vegetables and milk and dairy products than those in the mountain area. The reason for the variation in findings between the surveys was not clear, but it could have been related to changes over time, the season of the survey, income or regional differences. Therefore, for comparison with our previous findings, we surveyed the dietary intake of Nepalese living in the Chitwan district of the southern agricultural Terai region where residents were self 1000 -supporting but lived on a low income. We found some nutrient deficiencies and discuss the nutritional status of the people living in this rural region of Nepal.

Subjects and methods

The subjects were a random sampling from among the general populace who came to a medical camp for a routine health check and consisted of over 50% of the population of a village in Khargual of the Chitwan district, an agricultural Terai region of Nepal. The study was conducted on 55 males and 54 females of ages ranging from 10 to 68 years (average 28.8 12.7 years).

The average life-span of the Nepalese is 53-54 years. The majority of the residents in this district were engaged in agriculture and were peasants. Most of them were Hindu believers.

Height and body weight were measured for all subjects, and body mass index (BMI) was calculated as weight/height2 (kg/m2). Systolic (SBP) and diastolic blood pressure (DBP) were measured for 108 subjects (55 males and 53 females).

The dietary survey was carried out in December, 1989 by the 24-hr dietary recall method. Food models were used to obtain descriptions of the amounts of food consumed. In addition, information was obtained from local residents on the usual dietary habits and the consumption of minor food groups such as seasoning and local foods. The data were analysed and nutrient intake was calculated from food tables of India and Japan. Foods not listed in the tables were substituted with similar items.

All results are expressed as mean SD. Student’s unpaired t test was used to assess the statistical significance of difference. Pearson’s correlation coefficients were computed to examine the relationship between the variables. Statistical analysis was performed by using STAX statistical software (Microcomputers in Medicine, Nakayama Shoten, Tokyo).

Results

The physical characteristics of the subjects are summarised in Table 1. The mean values of height and body weight for males were significantly higher than those for females (p<0.01, respectively). However, the mean level of BMI was almost the same for both sexes (18.5 1.7 for males and 18.0 l.8 for females), showing that they were rather lean. SBP and DBP were 129.4 14.1 and 82.6 7.9 mmHg for males and 123.8 l5.5 and 77.7 8.9 mmHg for females, respectively (p<0.05 for SBP, p<0.0l for DBP). These values were not influenced by age.

Table 1. Physical characteristicsa of subjects.

1000
Sex

Subject

Height

Weight

BMI

Blood pressure b

         

SBP

DBP

  (age)

(n)

(cm)

(kg)

(kg/m2)

(mmHg)

Male 10-14

0

         
  15-19

14

159 7

43.9 5.7

17.2 1.2

125.0 9.1

80.0 7.7

  20-29

18

161 16

51.7 5.8

18.7 1.4

135.0 17.1

84.6 8.5

  30-39

12

165 6

50.7 5.9

18.6 1.2

129.8 13.0

85.8 6.9

  40-49

5

163 8

49.1 1.7

18.5 1.5

113.0 8.4

77.2 6.4

  50-59

4

164 4

55.6 6.6

20.8 3.2

123.0 4.8

80.0 7.5

  60-68

2

159 2

48.5 2.1

19.3 1.4

150.0 0

83.0 9.9

  All c

55

162 10**

49.3 6.4**

18.5 1.7

129.4 14.1*

82.6 7.9**

Female 10-14

3

139 11

28.7 6.1

14.7 1.1

109.3 1.2

64.7 5.0

  15-19

11

152 6

42.5 5.0

18.8 2.2

118.5 5.8

73.1 5.9

  20-29

19

154 5

44.1 4.8

18.6 1.4

128.3 22.7

79.9 10.0

  30-39

9

151 5

38.2 3.7

16.7 0.9

120.2 10.1

78.9 7.8

  40-49

8

147 5

39.8 2.6

18.3 1.2

127.0 11.6

79.8 7.7

  50-59

4

152 7

42.0 4.0

18.3 1.4

130.0 0

84.0 4.3

  60-68

0

         
  All c

54

151 6**

41.1 5.6**

18.0 1.8

123.8 15.5*

77.7 8.9**

a Mean SD; b Total number of subjects : 55 males and 53 females; c Significant differences between the sexes, *p<0.05, **p<0.01.


Table 2 shows the average daily food intake of the subjects. Considerable variation was found among individuals for the amount of food consumption, although the mean number of food items, excluding seasoning and alcohol, was 7.2 2.4 per day. All of the subjects consumed rice, seasoning and vegetable oil. Vegetables, potatoes and milk and dairy products were frequently consumed. The proportion of consumption of rice, coloured vegetables and milk and dairy products was 65.6 and 72.5% of the total weight of the food intake for males and females, respectively. The average amounts of rice consumed for males and females were 464 80 and 408 105 g per day, respectively, which constituted almost half of the total weight of the food intake, and the males consumed more rice than the females (p<0.01). The males also consumed much more alcohol (13.7% of the total weight of the food intake), but no significant difference was observed with age. A significant positive correlation was found between age (subjects 20-30 years old vs. teenagers and those over 40 years old vs. those 20-30 years old) and the amount of milk and dairy product intake (r = 0.28, p< 1000 ;0.01) while there was a negative correlation between age and the amount of rice intake (r= -0.25, p<0.01). The amounts and frequency of meat, fish or egg consumption were very low for both sexes, which meant that milk and dairy products were almost the sole food source of animal origin.

Table 2. Average daily food group consumptiona of subjects.

Food group

All

Maleb

Femaleb

(g/day)

(n=109)

(n=55)

(n=54)

Cereals

458 107

483 92*

433 115*

Rice

436 97

464 80**

408 105**

Wheat

5 22

3 14

7 28

Potatoes

60 86

67 91

53 82

Sugar & sweetenings

4 6

5 8*

2 4*

Fats & oils

8 6

7 5

9 7

Pulses

8 15

9 17

7 12

Fruits

2 12

3 17

0

Vegetable: coloured

173 127

179 126

167 129

other

82 128

71 99

94 151

Seasoning

5 3

5 3*

4 2*

Alcohol c

86 193

153 252**

18 43**

Fish

13 32

13 31

13 33

Meats

19 43

14 41

24 45

Eggs

2 14

2 16

2 11

Milk & dairy products

101 191

91 177

111 206

Total food weight

1034 344

1120 348**

946 320**

a Mean SD. b Significant difference between the sexes, *p<0.05, **p<0.01 c alcoholic beverage, not ethanol, principally fermented liquor or whisky.

The nutrient composition of diets is shown in Table 3. Age was negatively correlated with the average intakes of protein (r= -0.18, p<0.05), carbohydrate (r= -0.19, p<0.05), vitamin B1 (r= -0.23, p<0.05), and niacin (r= -0.23, p<0.05). Energy and intake of carbohydrate, Fe and vitamin E were higher for males than for females (p<0.01). The average intakes of animal protein and fat were slightly higher for females, but did not differ significantly between males and females. The daily mean intakes of Ca, K, vitamin A, B2 and C were almost the same for both sexes.

Table 3. Daily average nutrient intakea of subjects.

Nutrient

All (n=109)

Male (n=55)b

Female (n=54)b

Energy (kcal)

2137 532

2340 526**

1930 457**

Protein (g)

49.6 12.9

51.9 13.0

47.4 12.5

animal protein (g) 8.8 9.3

7.6 9.6

9.9 8.9

Fat (g)

24.5 12.0

23.0 9.8

26.1 13.8

animal fat (g)

7.9 9.7

6.2 7.7

9.6 11.1

Carbohydrate (g)

404 100

449 96**

359 81**

Dietary fibre (g)

15.9 8.7

15.9 5.2

15.8 11.3

Ca (mg)

404 232

412 228

395 237

P (mg)

1160 283

1214 241*

1104 312*

Fe (mg)

7.6 2.9

8.5 3.4**

6.7 1.9**

K (mg)

2010 731

2080 774

1939 685

Vitamin A (IU)

1588 1013

1614 1003

1561 1031

Vitamin B1 (mg)

1.80 0.37

1.88 0.33*

1.72 0.39*

Vitamin B2 (mg)

0.71 0.29

0.73 0.27

0.68 0.31

Niacin (mg)

14.9 3.7

15.6 3.8*

14.2 3.5*

Vitamin C (mg)

117 61

12 1000 0 59

114 63

Vitamin E (mg)

4.0 1.4

4.4 1.5**

3.7 1.2**

aMean SD; bSignificant difference between the sexes, *p<0.05, **p<0.01.

As shown in Table 4, the proportion of energy intake from protein and fat was higher for females (p<0.01, respectively) and that of carbohydrate was higher for males (p<0.01). Rice appeared to contribute most to the total energy intake in both sexes, which constituted of about 74% of the total energy intake.

Table 4. Contribution of nutrients and rice to total energy intakea

Subject

N

Sources of energy (%)

   

Protein

Fat

Carbohydrate

Rice

All

109

9.8 1.6

10.8 4.4

79.4 5.1

74.0 14.2

Males

55

9.4 1.1**

9.3 3.2**

81.3 3.9**

72.5 15.4

Females

54

10.3 1.8**

12.2 5.0**

77.5 5.5**

75.6 12.8

a Mean SD. **Significant difference between the sexes, p<0.01.


The results of correlation analysis among major food items and nutrient intake for all subjects are presented in Table 5. Rice correlated most strongly with energy intake (r =0.60, p<0.001), protein (r =0.44, p<0.001), carbohydrate (r = 0.66, p<0.001), vitamin B1 (r = 0.77, p<0.001), niacin (r =0.53, p<0.001) and vitamin E (r = 0.54, p<0. 001). Coloured vegetables showed cor-relations with Ca (r = 0.63, p<0.001), vitamin A (r = 0.96, p<0.001), B2 (r = 0.37, p<0.001) and C (r = 0.85, p<0.001). Milk and dairy products were correlated with fat (r = 0.42, p<0.001), Ca (r = 0.63, p<0.001) and vitamin B2 (r = 0.63, p<0.001). However, Fe was only correlated with meats (r = 0.39, p<0.001). Ca, vitamin A and C were not correlated with energy. Several other food groups were correlated with only a few dependent variables (not presented in the table).

Table 5. Correlation among food consumption and nutrient intake.

Nutrient

Rice

Fish

Meats

Milk & dairyproducts

Coloured vegetables

Energy

0.60***

0.15

0.21*

0.12

-0.07

Protein

0.44***

0.31***

0.43***

0.19*

0.05

Fat

0.23*

-0.03

0.46***

0.42***

0.02

Carbohydrate

0.66***

0.12

0.06

0.07

-0.10

Ca

0.01

-0.22*

-0.01

0.63***

0.63***

Fe

0.13

0.23*

0.39***

-0.08

0.14

Vitamin A

--

-0.21*

0.17

0.11

0.96***

Vitamin B1

0.77***

0.24**

0.07

0.19

--

Vitamin B2

0.14

-0.06

0.24**

0.63***

0.37***

Niacin

0.53***

0.04

0.63***

0.02

0.15

Vitamin C

-0.05

-0.19*

0.12

0.12

0.85***

Vitamin E

0.54***

0.33***

0.04

--

-0.11

*p<0.05, **p<0.01, ***p<0.001

Discussion

The mean height of the subjects in this study was almost the same as that given in the previous report6, but that of body weight was lower, resulting in lower BMI values. This might be explained by greater energy expenditure for the subjects compared with energy intake and also by 1000 the difference in the daily activities between the two areas (subjects in this study were peasants while those in the previous one were factory workers). The blood pressure levels (DBP and SBP) for the subjects were within the normal ranges by Japanese standards. The mean values of DBP of males and females were about the same as those of Nepalese in the Itahari district6 and African Americans7 reported by Melby et al, while those of SBP were higher than those reported previously.

Milk and dairy products were almost the sole food source of animal origin, as found for the Itahari district6. Food habits such as having milk tea or boiled rice with milk led to the subjects consuming fairly large amounts of milk. The average daily consumption of rice and coloured vegetables in this study was higher than those of Japanese8 and Nepalese in the Itahari district6; the intake of coloured vegetables was about 3.5 times higher than in the Itahari district6. This might be explained by the facts that it was just after the rice harvest and that the land was also good for cultivating vegetables throughout the seasons compared with mountain or industrial areas in Nepal.

The dietary pattern was very simple in this area and similar to that reported previous1y5,6. An average of seven food items was consumed in this area, which was fewer than the average of 22 for the Japanese8 and 18 for the Nepalese in the Itahari district6. This showed that food availability and cash income greatly influenced food intake. Due to the large amounts of rice intake, its proportion in the total energy intake of Nepalese in this study was higher than those in the mountain area9 and in the Itahari district6. The energy percentage of carbohydrates for Nepalese in this study was almost the same as those for South Africans9, Polynesians10 and other Nepalese4-6,11, but was higher than those in developed coun-tries12,13 and among vegetarians7,14. The average intake of protein was about the same level as that reported elsewhere for Nepalese4-6,11 and that of fat was the same as for the Nepalese in the 19 villages reported earlier4 and in Kathmandu11 but was lower than that in the Itahari district6. Rice intake contributed to the intake of protein, fat, vitamin B1, niacin and vitamin E, however, compared with a previously studied vegetarian diet of 2200 kcal14, the intake of protein and fat was less and that of Ca, vitamin E, niacin and Fe was considerably less than the vegetarians. Ca intake mainly came from consumption of milk and dairy products and coloured vegetables which was higher than those in the 19 villages4, in the mountain area5 and in the Itahari district6. However, the consumption of milk and dairy products was lower in this study than that in the Itahari district6.

Fe intake was related to meat consumption, but this was very low in amount and frequency in this study, as found with the diets of vegetarian adults15. Fe intake in this study was only 56 to 65% of that in the Itahari district6. We found that the dietary Fe was not related to the serum Fe concentration and that the average percent saturation of serum transferrin was around 20-25% in this area (to be published in a separate paper), which tended to be lower than that of the normal range (20-55%)16. Thus, there seems to be a latent iron deficiency. Black gram, a kind of pulse commonly eaten in Nepal, contains about 15 mg/100 g of Fe (unpublished data). The average intake of pulses for Nepalese in this area was below one-fifth of that in the Itahari district6. We do not have precise information on the kind of pulse 1000 s consumed in the Itahari district, but the difference in the amount of pulse consumption between these two areas might be the reason for the lower Fe intake found in this study because the amount of animal origin food intake did not differ much between the two areas.

Dietary fibre is known to play an important role in human health17,18 but increasing its amount can disturb the absorption of nutrients such as protein, fat and minerals19,20. This would be a problem for children and pregnant or lactating women in developing countries because of the lower bioavailability of important nutrients. The average intake values for dietary fibre by males and females in this study were 15.9 5.2 and 15.8 11.3g, respectively, which were about the same as those in the Netherlands (18g)13 and the United States (15.4 8g)21 and among the elderly in Norwich, Great Britain (20.9g for males and 17.4g for females)22, but they were about half of that of vegetarians (30-40g)7,14. Thus, although the amount of dietary fibre intake in this area was not considerably higher, the net amounts of bioavailability of those nutrients might be affected due to the overall low nutrient intake.

Examining the average intakes of the various nutrients showed that the level for vitamin A was within the range of the other reports4-6,11 and was lower than that of the Japanese8. About 90% of vitamin A was from carotene, which agreed with the lesser consumption of animal origin food. Carotene is readily available from vegetables from the people’s gardens throughout the year.

The average intake of vitamin B1 was higher than those of Japanese8 and Americans12, but was lower than those in the 19 villages4 and in the Itahari district6. The average intake of vitamin B2 was the same level as those of the 19 villages4 and in the mountain area5 but was lower than those in the Itahari district6 and for Japanese8 and Canadian students23. Niacin intake for this study was the same level as that in the Itahari district6 but was lower than that in the 19 villages in Nepal4 and among Canadian students23. The main source of both nutrients, vitamin B1 and niacin, was apparently rice. The residents eat more nutritive half-polished rice than the all-polished type. The average intake of vitamin C, which showed good correlation with the consumption of coloured vegetables, was the same as those in the Itahari district6 and in Japan8, was lower than that in the mountain area5 and was higher than that in the 19 villages4. The average intake of vitamin E was the same level as that of 7-11-year-olds in Britain found by Nathan et al (4.4-5.6 mg)24. Horwitt et al25,26 reported that the vitamin E requirement was 4mg of a-D-tocopherol per day for persons whose polyunsaturated fatty acid (PUFA) intake was very low. For the Japanese, 8-10mg of vitamin E is considered to be adequate27. Judging from the food consumption of Nepalese in this study, 6-8mg of vitamin E might be sufficient because their PUFA intake was much lower than that for the Japanese.

In general, the nutritional status of Nepalese in this study was almost the same as that reported previously. They were apparently healthy, despite the fact that there may be a latent deficiency of protein, Ca, Fe, vitamins A and B2 and a lack of high quality amino acids because of le 1000 sser intake of animal origin food groups such as meats, fish, or eggs. The status of food consumption was greatly influenced by food habits, food availability, and socioeconomic conditions. The residents can grow some agricultural products throughout the year because they live in a southern arable farm village but the variety of food is limited due to their 1ow income. The usual diet in the research area consists of plenty of boiled rice, thin soup of pulses and cooked vegetables. Although it is very difficult to change food habits and it takes time to improve the nutritional status, we would suggest the consumption of thicker soups of pulses, more variety of vegetables, and animal origin foods. The quality of the diet rather than its quantity should be improved to raise the nutritional status as a whole.

References

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Food consumption patterns and nutrient intake among Nepalese living in the southern rural Terai region

Yoshimi Ohno, Kazuko Hirai, Noriko Sato, Masashi Ito, Teruko Yamamoto, Toshihide Tamura and Mathura P Shrestha

Asia Pacific Journal of Clinical Nutrition (1997) Volume 6, Number 4: 251-255

Food consumption patterns and nutrient intake among Nepalese living in the southern rural Terai region

Yoshimi Ohno, Kazuko Hirai, Noriko Sato, Masashi Ito, Teruko Yamamoto, Toshihide Tamura and Mathura P Shrestha

Asia Pacific Journal of Clinical Nutrition (1997) Volume 6, Number 4: 251-255


Copyright 1997 [Asia Pacific Journal of Clinical Nutrition]. All rights reserved.
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