Dietary assessment using a novel image-voice-based system indicates nutrient inadequacies in Cambodian women's dietary intake

Abstract

Women and children are priority populations in Cambodia, however no dietary intake information exists on breastfeeding women for informing nutritional intervention. The aim was to assess nutritional adequacy of dietary intakes of Cambodian women, by breastfeeding status and locality. A cross-sectional assessment of dietary intake was conducted with non-pregnant women ≥18 years of age with at least one child under 5 years in rural, semi-rural and urban locations in Siem Reap province, Cambodia. Women used a bespoke smartphone application to capture three-day image-voice records on two occasions. Data were analysed using a semi-automated web platform incorporating a tailored Cambodian food composition database. Estimated Average Requirements were used to assess adequacy of nutrient intakes. Of 119 women included in the analysis, 58% were breastfeeding, and 63% were rural or semi-rural. Protein, carbohydrate, vitamin B₁₂, iron, and sodium were adequate for over 65% of women. Less than 10% of women had adequate vitamin A, vitamin C, thiamine, calcium, and zinc intakes, in contrast to low deficiency rates reported for Cambodian women. Despite breastfeeding women recording higher dietary intakes, adequate intakes of protein, carbohydrate, vitamin A, thiamine, and zinc were lower than non-breastfeeding women due to higher requirements. Rural women generally had higher nutrient intakes, and urban women had inadequate folate intake. This study indicates dietary intakes of Cambodian women in Siem Reap province, particularly breastfeeding women, are not nutritionally adequate. Data collected using image-voice dietary assessment could inform nutrition interventions and policies in Cambodia to improve dietary intakes and nutrition-related health outcomes.

Keywords: AI, adequate intake; ASEAN, association of southeast asian nations; BF, breastfeeding; BMI, body mass index; CMS, content management system; Cambodian women; Dietary assessment; EAR, estimated average requirement; FCD, food composition database; IOM, institute of medicine; IQR, interquartile range; Image-voice-based method; LMIC, low middle income country; NA, not applicable; NASEM, national academies of science engineering and medicine; NBF, non-breastfeeding; NGO, non-government organisation; NRV, nutrient reference value; Nutrient adequacy; Nutrient intake; RA/RAs, research assistant/s; SD, standard deviation; SMILING, sustainable micronutrient interventions to control deficiencies and improve nutritional status and general health in asia initiative; SPSS, statistical package for the social sciences; STROBE-nut, strengthening the reporting of observational studies in epidemiology – nutritional epidemiology; VISIDA, voice-image solution for individual dietary assessment; WHO, World Health Organization; WRA, women of reproductive age.

Graphical abstract

Fig. 1.

Participant flow diagram of recruitment, data collection, and analysis for Voice-Image Solution for Individual Dietary Assessment (VISIDA) study conducted in Siem Reap province, Cambodia.