This cross-sectional study provides data on the nutritional status and dietary intake of urban residents in Gondar city, Northwest Ethiopia. The results of this study indicate that the diets of urban residents included in this study are undesirable according to the Dietary Reference Intakes (DRIs) used. Overall, participant diets included too much energy-dense food and saturated fat and inadequate intakes of micronutrients. The men seem to have more than adequate intake compared to women. Irrespective of sex, micronutrient intake is very low in the area. BMI data point out the prevalence of a high percentage of overweight and obese subjects in both sexes.
The results also showed that males had a greater mean in BMI and Waist-to-Hip Ratio (WHR) than females, related to physiological differences between male and females [22
]. Higher BMI and WHR may be considered as indicators of high risk factors for cardiovascular disease since they have strong relation to lipid profile in both sex groups [22
]. A considerable proportion of urban residents (21.3%) in Gondar had overweight and obesity in contrast to previous reports of low prevalence of overweight in Ethiopia [27
]. Increased dietary energy and fat intake, coupled with insufficient physical activity, is implicated in the rapidly growing prevalence of overweight and obesity in sub Saharan Africa, where there is a longstanding tradition favoring obesity over thinness. Overweight in general, and abdominal obesity in men, is regarded as a sign of health and wealth in many communities in Africa, including Ethiopia. Thinness, in contrast, is considered as a sign of illness or poverty [25
Although, there is limited data on the BMI distribution or prevalence of overweight and obesity in sub Saharan African countries, in other African countries, the prevalence of obesity was consistently higher in urban areas [24
Although, eating more vegetables and fruits as the part of Dietary Approaches to Stop Hypertension (DASH) diet are associated with reduced risk for cardiovascular diseases [28
] In Gondar and most cities in the country, people are reluctant to consume vegetables especially in commercial food catering places and in social occasions where food is served to large number of guests. There is widespread fear of infection, particularly with amoeba, from consuming uncooked vegetables. It is common to see that a large part of the vegetables cultivated in cities are contaminated with water that is contaminated with sewerage and use of infected manure as a fertilizer.
Fruits are not also part of the regular daily diet in Ethiopia. Unlike other populations where fruits follow meals for dessert, instead tea and coffee are the predominant accessories to meals in this population. Fruits are more commonly consumed during weekends, social occasions or holidays. They are the preferred gift while visiting sick people (patients) at home or in health facilities. The price of common fruits, such as oranges and bananas, has remained generally low for many years in Ethiopia until a recent surge, which was partly attributed to increasing exports. In addition, according to results of this study, consumption of fish is very small due to cultural aversion to eating fish although one of the biggest lakes (Lake Tana) is only 60
km from Gondar.
Intake of fat by the study participants was higher than the suggested acceptable macronutrient distribution range which is a negative impact of nutrition transition [29
]. The dietary changes of the nutrition transition involve large increases in the consumption of fat (especially saturated fat) and sugar, marked increases in animal products, and a decline in unrefined cereal and, thus, in fiber intakes [32
]. It is recommended that fiber intake could be improved by taking whole grain than refined grain intake; thus, nutrition education programs are needed to improve the dietary intake and for healthy eating pattern [34
]. As in many sub-Saharan Africa countries, in Ethiopia, an increased level of body fat is associated with beauty, prosperity, health, and prestige, despite its negative impact on health. Thinness, in contrast, is perceived to be a sign of ill health or poverty and is something to be feared and avoided, particularly in recent years, when it has been associated with AIDS [26
Micronutrients are required for virtually all metabolic and developmental processes. The large percentage of study subjects with inadequate intakes of calcium, retinol, thiamin, riboflavin, niacin and ascorbic acid indicates that micronutrient deficiencies are still major public health problems in developing countries [36
]. These dietary pattern changes in which the macronutrient pattern could already be associated with an increased risk of overweight, obesity and other non communicable diseases [39
] while the improvements in micronutrient intakes in urban subjects, did not reach recommended values for some micronutrients [34
]. It is conceivable that in many overweight and obese subjects, sub-optimal micronutrient intakes could lead to a “double burden” of co-existence of under- and over-nutrition in the same person. It is further conceivable that some of the observed micronutrient deficiencies, such as those with anti-oxidant properties, could contribute to the increased risk of non communicable diseases in these subjects.
Our data agree with previous studies in different countries suggesting lower intakes of essential nutrients, vitamins, and minerals, especially calcium, thiamin and niacin in developing countries during nutrition transition [42
]. It is understandable that with economic development, people will choose to follow a more palatable diet than traditional diets high in fiber and low in fat. But it is more difficult to understand why adult Africans, often from poor, food-insecure households, are so vulnerable to obesity when they experience the nutrition transition. It has been suggested that based on the Barker hypothesis [45
] of fetal programming for vulnerability to non communicable diseases in later life when the expectant mother is nutritionally compromised, stunted children and adults born from these mothers in African households are more vulnerable to obesity when they are suddenly following a modern, “Western” diet [46
This study has also shown that the major determinants for frequency of food consumption among adults are socioeconomic. The more income the family generates, the better their frequency of food consumption and hence BMI. Although not statistically significant, level of education is negatively correlated with frequency of consumption for oil and butter. Health education campaigns warning against butter as source of saturated fatty acids and recommending unsaturated fats might have influenced the behaviors of the highly educated in the study area. Nutrition education of the masses needs to be intensified to encourage a healthy lifestyle. Food fortification programmes to include micronutrients are also advocated.
The limitations of this study include single 24
h dietary recall, thereby providing a less precise measure of intake. The study did not include the rural communities due to financial constraint. Yet, the representativeness of the urban population samples to the corresponding strata in the whole country is limited due to possibly marked diversity in socioeconomic and cultural background of different populations in the country. Additionally, the cross-sectional nature of our study ruled out a determination of the role of poor diet in the development of high-risk anthropometric measures or the role of lack of knowledge of nutrition in making poor dietary habit.