Food Variety and Dietary Diversity Scores to Understand the Food-Intake Pattern among Selected Malaysian Households

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Food variety scores (FVS) and dietary diversity scores (DDS) were estimated based on foods consumed weekly by 285 Malaysian households using a food frequency questionnaire. The scoring system of FVS and DDS was based on a scale of 0–7 and 0–6
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  This article was downloaded by: [UNSW Library]On: 05 December 2012, At: 15:20Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Ecology of Food and Nutrition Publication details, including instructions for authors andsubscription information: Food Variety and Dietary Diversity Scoresto Understand the Food-Intake Patternamong Selected Malaysian Households Shamsul A. Zainal Badari a   b  , Jayashree Arcot a  , Sharifah A. Haron b , Laily Paim b  , Norhasmah Sulaiman b  & Jariah Masud ca  Food Science and Technology, School of Chemical Engineering,Faculty of Engineering, The University of New South Wales, Sydney,Australia b  Department of Resource Management and Consumer Studies,Faculty of Human Ecology, Universiti Putra Malaysia, Serdang,Selangor, Malaysia c  Institute of Gerontology, Universiti Putra Malaysia, Serdang,Selangor, MalaysiaVersion of record first published: 13 Jul 2012. To cite this article:  Shamsul A. Zainal Badari, Jayashree Arcot, Sharifah A. Haron, Laily Paim,Norhasmah Sulaiman & Jariah Masud (2012): Food Variety and Dietary Diversity Scores to Understandthe Food-Intake Pattern among Selected Malaysian Households, Ecology of Food and Nutrition, 51:4,265-299 To link to this article: PLEASE SCROLL DOWN FOR ARTICLEFull terms and conditions of use: article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden.The publisher does not give any warranty express or implied or make any representationthat the contents will be complete or accurate or up to date. The accuracy of anyinstructions, formulae, and drug doses should be independently verified with primarysources. The publisher shall not be liable for any loss, actions, claims, proceedings,demand, or costs or damages whatsoever or howsoever caused arising directly orindirectly in connection with or arising out of the use of this material.   Ecology of Food and Nutrition , 51:265–299, 2012Copyright ©  Taylor & Francis Group, LLCISSN: 0367-0244 print/1543-5237 onlineDOI: 10.1080/03670244.2012.674445 Food Variety and Dietary Diversity Scores to Understand the Food-Intake Pattern among Selected Malaysian Households SHAMSUL A. ZAINAL BADARI  Food Science and Technology, School of Chemical Engineering, Faculty of Engineering,The University of New South Wales, Sydney, Australia, and Department of Resource Management and Consumer Studies, Faculty of Human Ecology,Universiti Putra Malaysia, Serdang, Selangor, Malaysia  JAYASHREE ARCOT  Food Science and Technology, School of Chemical Engineering, Faculty of Engineering, The University of New South Wales, Sydney, Australia SHARIFAH A. HARON, LAILY PAIM, and NORHASMAH SULAIMAN  Department of Resource Management and Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia  JARIAH MASUD  Institute of Gerontology, Universiti Putra Malaysia, Serdang,Selangor, Malaysia  Food variety scores (FVS) and dietary diversity scores (DDS) were estimated based on foods consumed weekly by 285 Malaysianhouseholds using a food frequency questionnaire. The scoring  systemofFVSandDDSwasbasedonascaleof0–7and0–6respec-tively. The mean household FVS and DDS was 164.1  ±  93 and 6  ±  0.4. The age of respondents (husbands or wives; p  <  .01), sex (p  <  .05), and household food expenditure (p  <  .01) had a sig-nificant influence on both FVS and DDS. The food-intake patternof Malaysian households showed that their typical diets had high protein and energy-based foods. KEYWORDS Malaysia, households, food frequency question-naire, food-intake pattern, food variety scores, dietary diversity  scores   Address correspondence to Shamsul A. Zainal Badari, Food Science and Technology,School of Chemical Engineering, The University of New South Wales, Sydney, NSW 2052, Australia. E-mail:    D  o  w  n   l  o  a   d  e   d   b  y   [   U   N   S   W    L   i   b  r  a  r  y   ]  a   t   1   5  :   2   0   0   5   D  e  c  e  m   b  e  r   2   0   1   2  266  S. A. Zainal Badari et al. Healthy food intake is often associated with food variety and diet quality of individuals. The variety of food is often measured by counting the number of different foods and the dietary diversity measured by food groups (Clausenet al. 2005). Many studies (Nicklas et al. 2001; Foote et al. 2004; Savy et al.2005) have been conducted to measure the quality and variety of individualfoods, particularly for developed countries. The result of these studies isoften used in developing plans, policy and nutrition programs that lead toincreased nutritional status of the community (Kant et al. 1993). In addition,the formation of the index based on food variety and dietary diversity can bedeveloped such as the Healthy Eating Index (Kennedy et al. 1995) and DietQuality Index (Haines et al. 1999) from the United States and the ChineseDiet Quality Index (Stookey et al. 2000). A variety of foods was included in the dietary guidelines and it isbelieved that the wide food variety in the diets can provide adequateamount of nutrients to the individuals (Hodgson, Hsu-Hage, and Wahlquist1994). At the same time, it can reduce the under-consumption or over-consumption of single nutrients (Krebs-Smith et al. 1987), reducing theproblem of food contamination and include non-nutrient components of food that can enhance the quality of individual’s health (Hodgson et al.1994). There was great interest in the study of balanced and diversifieddiet especially in the developing countries due to under-nutrition and theirconsequences (WHO / FAO 1996; Underwood 1998) and other consequencesdue to over-nutrition (McCrory et al. 1999).The nutritional status of Malaysians is undergoing a transition (Khoret al. 2002). The changes in lifestyle including food production, food pref-erences, dietary habits, and other factors related to food are associated withchanges in health and disease patterns of Malaysians (Khor et al. 1998).Lifestyle changes in adults lead to unhealthy eating habits, socioeconomicpressure, and smoking and decreased physical activity and these will lead toincrease in chronic disease risk factors (Lam and Khor 1997). The principlecauses of death in Malaysia among men and women aged 15–64 years old in2007 were ischemic heart disease and cerebrovascular disease (Departmentof Statistics Malaysia 2009) and these are assumed to increase yearly. Someresearch shows that the main causative factors of these diseases were over- weight and obesity that often related to unhealthy food intake, poor dietary habits and sedentary lifestyles (Norlaila 2008; Kee et al. 2008; He and Evans2007; Williams 2004; Lam and Khor 1997).The Third National Health and Morbidity Survey of Malaysia (NHMS III2006) shows that 29.1% of adults were overweight and 14.01% of the adults were obese, of which women had higher obesity prevalence (17.35%) thanmen (10.01%), while prevalence of overweight and underweight among chil-dren was 13.23% and 5.36% respectively with the prevalence of overweightbeing higher in boys (Ministry of Health Malaysia 2006; Narayan and AbdulRashid 2007; Norimah and Haja Mohaideen 2003). The prevalence increased    D  o  w  n   l  o  a   d  e   d   b  y   [   U   N   S   W    L   i   b  r  a  r  y   ]  a   t   1   5  :   2   0   0   5   D  e  c  e  m   b  e  r   2   0   1   2   Food Variety and Dietary Diversity Scores   267 in rural areas and among lower-income groups and it seems that the level of overweight and obesity among adults has increased three times comparedto the results from the Second National Health and Morbidity Survey (NHMSII) in 1996. However, The Malaysian Adult Nutrition Survey in 2003 reportedthat energy intake among adults was lower than the Recommended NutrientIntake for Malaysia (Ministry of Health Malaysia 2003, 2005). The underesti-mation of dietary intake in some people may reflect in the energy intake of the population (Mirnalini et al. 2008).In the past decade, Malaysia has been enjoying rapid growth andlow inflation rates. However, in the beginning of the year 2004, the con-sumer price index (CPI) that measures the inflation showed an increasedue to recent increases in fuel prices and lead to the imbalance in incomesamong Malaysians especially in the rural and urban areas (Prime MinisterDepartment Malaysia 2006), and decreased spending power for those inthe lower-income groups. Studies on food expenditure in Malaysia showedthat lower-income households spend the majority of their income to pur-chase foods. However, the spending was more on high fat and energy densefoods with higher palatability due to the lower prices which was similar tothe lower-income groups in other developing countries (Abbott 2009) andUnited States (Zhang and Chen 2007).The lower- and middle-income households were more price-responsiveand sensitive than higher-income households, especially regarding food(Powell et al. 2009). Consumers purchased their foods based on their per-ception of availability and price and these perceptions were based on theincome and socioeconomic background of the consumers (Giskes et al.2007). People in lower socioeconomic levels always perceived a recom-mended healthy diet to be more expensive (Kearney and McElhone 1999;Giskes et al. 2002) and bought foods that were more cheaply available com-pared to food that is generally considered healthy and recommended by thedietary guidelines (Giskes et al. 2007). Another reason that contributed tothe spending on cheaper foods was accessibility. Buras (2006) reported thatrural areas had smaller number of food stores that could provide a variety of healthy food products, and most of the food was expensive. This factor lim-ited the access to healthy food to lower-income households, and encouragedthis group to buy unhealthy food that was more accessible and affordable.To date, many studies have been done to determine the nutritionalstatus of lower-income households especially in rural areas in Malaysia(Norlaila 2008; Kee et al. 2008; Narayan and Abdul Rashid 2007; Norimahand Haja Mohaideen 2003; Chee, Ismail, and Zawiah 1997; Ismail and Vickneswary 1999), but there has been no attempt made to assess and usethe food variety and dietary diversity scores as a measure of food-intake pat-terns of Malaysian households except from Saibul and colleagues (2009) andMohd Shariff and Khor (2005). This study investigated whether food variety scores and dietary diversity scores can be used to determine the food-intake    D  o  w  n   l  o  a   d  e   d   b  y   [   U   N   S   W    L   i   b  r  a  r  y   ]  a   t   1   5  :   2   0   0   5   D  e  c  e  m   b  e  r   2   0   1   2  268  S. A. Zainal Badari et al. patterns of Malaysian households in urban and suburban areas in Malaysia. At the same time this study investigated the association of location, age, sex,household incomes, and food expenditures of Malaysian households withtheir food scores. METHODOLOGY The Sampling Frame This study was carried out in Klang Valley, Peninsular Malaysia. Klang Valley is located in the middle of the state of Selangor and Kuala Lumpur and com-prises of several suburbs. Klang Valley has more than three million people,and is the industrial and commercial center in Malaysia. In the first stage, thelist of areas within the vicinity of Klang Valley was identified through strat-ified random sampling. Two districts were randomly selected from the listof districts. In the second stage, the sub-districts within the districts selected were listed. From the list, two areas were selected. For each area, list of housing areas within the radius of 10 km from respective town centres wereidentified. Three housing areas were then randomly selected for each area.Systematic sampling was used to select the households by choosing theodd-numbered houses. The spouses of heads of household (father or thehusband) who came from two-parent households with children qualifiedas respondents to be interviewed for their household food intake in thisstudy. Therefore, if the selected household did not qualify or if nobody wasaround for the interview, the researcher went to the next odd-numberedhouse. Moreover, respondents were among those who were familiar withfood preparation at home such as the housewife or mother, or head of household (father or the husband) if the mother or wife was not at home ornot confident to participate in the interview. Two hundred and eighty fiverespondents were selected for this study. This study was approved by theMedical Research Ethics Committee of the Faculty of Medicine and HealthSciences, Universiti Putra Malaysia. Informed consent was obtained fromeach respondent before interview. Survey Instruments H OUSEHOLD BACKGROUNDS  A household questionnaire was developed to obtain the sociodemographicand socioeconomic background of the respondents. The questionnaire con-sisted of three sections: (1) household background including location, sex,race, age, education level and household size; (2) household income andexpenditure on foods; and (3) frequency of food prepared at home. Thisquestionnaire was administered by a trained interviewer to collect theinformation from respondents.    D  o  w  n   l  o  a   d  e   d   b  y   [   U   N   S   W    L   i   b  r  a  r  y   ]  a   t   1   5  :   2   0   0   5   D  e  c  e  m   b  e  r   2   0   1   2
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