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There is an urgent need to develop sustainable and impactful interventions to mitigate the high risk of diet-related non-communicable diseases (diet-NCDs) in South Asians living in high-income countries. The current study using a co-design methodology aimed to identify community-led intervention components (solutions) to address barriers and enablers of disease-promoting dietary and physical activity behaviours in New Zealand South Asians. Data were collected from South Asian immigrants aged 25–59 years via three focus group discussions (n = 21) and 10 telephone or face-to-face interviews between 2018 and 2019. The thematic analysis resulted in identifying 22 barrier and enabler codes and 12 solution codes which were summarised under five themes. The key solutions (intervention components) to mitigate the identified target behaviours were providing recipes for using local vegetables in South Asian cuisine, information on the nutritional quality of frozen vegetables and canned lentils, simple home gardening techniques, the saturated fat content of dairy foods, interpreting nutrition labels, optimal portion sizes of foods, and framing low-fat messages positively. Similarly, group-based activities with peer support such as walking, cultural dancing and community sports like cricket, football, and tennis were the identified solutions to increase physical activity levels. The identified solutions for health promoting dietary habits and physical activity levels could be part of any targeted multicomponent health promoting programme to reduce the risk of diet-NCDs in South Asian immigrants.
Selenium (Se) is a mineral with several biological functions, and studies have shown that its deficiency can be linked to many complications in patients with chronic kidney disease (CKD). This study aims to systematically review the effects of Se supplementation in patients with CKD undergoing haemodialysis (HD). This systematic review was carried out according to the PRISMA statement. Clinical trials were searched in PubMed, Lilacs, Embase, Scopus and Cochrane Library databases from inception to July 2021 and updated in July 2024. The protocol was registered on PROSPERO (CRD42021231444). Two independent reviewers performed the study screening and data extraction, and the risk of bias was evaluated using the Cochrane Collaboration tool. Thirteen studies were included in this review. Only nine studies showed results on Se levels; in all, reduced Se levels were observed before supplementation. A positive effect of supplementation on plasma Se level was demonstrated. Of the ten studies analysed, six demonstrated positive effects on antioxidant and inflammatory markers. Only one study analysed immunological parameters, showing a positive impact. From two studies that analysed thyroid hormones, only one showed positive results. All studies were classified as high risk of bias. The findings suggest that Se supplementation significantly increases plasma Se levels in these patients; however, there are still not enough studies to clarify the effects of Se supplementation on the antioxidant and inflammatory markers, immune system and thyroid hormones. Further studies are needed to elucidate the effects of Se supplementation and to provide a recommendation for patients with CKD undergoing HD.
To assess the relationship between dietary intake of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein+zeaxanthin (LZ) and occurrence of metabolic dysfunction-associated fatty liver disease (MAFLD).
Design:
Cross-sectional study design. The MAFLD diagnosis was based on hepatic steatosis and metabolic dysregulation. Carotenoid intake was adjusted for using an energy-adjusted model. Logistic regression and restricted cubic spline (RCS) analyses were used to assess the relationships, with sensitivity analysis to validate the findings. Weighted quantile sum regression (WQS) was used to explore the combined effect of these carotenoids on MAFLD. Subgroup analyses were conducted to identify population-specific associations.
Setting:
National Health and Nutrition Examination Survey (NHANES) 2017–March 2020.
Participants:
This study included 5098 individuals aged 18 years and older.
Results:
After adjusting for potential confounders, a weak inverse association was observed between α-carotene and β-carotene intakes and MAFLD occurrence (all P value <0·05). The highest quartile of β-carotene intake showed a significantly lower occurrence of MAFLD compared with the lowest quartile (OR = 0·65; 95 % CI: 0·44, 0·97). RCS analysis showed that a significantly lower occurrence of MAFLD was associated with a higher intake of the four carotenoids, excluding lycopene. Furthermore, the WQS analysis revealed a negative relationship between combined carotenoid intake and MAFLD occurrence (OR = 0·95, 95 % CI: 0·90, 1·00, P = 0·037). Subgroup analyses showed dietary carotenoid intake was associated with reduced MAFLD occurrence in populations aged 50–69 years, females, physically active individuals and non-drinkers.
Conclusion:
Higher dietary intake of carotenoids is associated with lower MAFLD occurrence. However, this relationship varies among individuals of different ages, sexes and lifestyles.
The International Code of Marketing of Breast-Milk Substitutes is an important instrument to protect and promote appropriate infant and young child feeding and the safe use of commercial milk formulas. Ghana and Tanzania implemented the Code into national legislation in 2000 and 1994, respectively. We aimed to estimate the effects of the Code implementation on child mortality (CM) in both countries.
Setting:
The countries analysed were Ghana and Tanzania.
Participants:
For CM and HIV rates, data from the Institute for Health Metrics and Evaluation from up to 2019 were used. Data for income and skilled birth rates were retrieved from the World Bank, for fertility from the World Population Prospects, for vaccination from the Global Health Observatory and for employment from the International Labour Organization.
Design:
We used the synthetic control group method and performed placebo tests to assess statistical inference. The primary outcomes were CM by lower respiratory infections, mainly pneumonia, and diarrhoea and the secondary outcome was overall CM.
Results:
One-sided inference tests showed statistically significant treatment effects for child deaths by lower respiratory infections in Ghana (P = 0·0476) and Tanzania (P = 0·0476) and for diarrhoea in Tanzania (P = 0·0476). More restrictive two-sided inference tests showed a statistically significant treatment effect for child deaths by lower respiratory infections in Ghana (P = 0·0476). No statistically significant results were found for overall CM.
Conclusion:
The results suggest that the implementation of the Code in both countries had a potentially beneficial effect on CM due to infectious diseases; however, further research is needed to corroborate these findings.
Dietary surveys are critical in evaluating dietary trends prevailing across the entire population. The aim of this study is to present the results of the latest research into the intakes of energy, macronutrients, and micronutrients amongst the adult population in Lithuania from 2019 through 2020. A cross-sectional study was conducted and dietary data was collected using a 24-h dietary recall method from a total of 2555 Lithuanian adults. Medians, 25th and 75th percentiles were calculated. The diet of Lithuanian adults was found insufficient as the energy intake from fats exceeded the recommended norms, while the energy intake from carbohydrates was below the lower range. The intakes of dietary fibre and most vitamins and minerals were insufficient. Men, compared to women, had a statistically higher total energy intake and energy intake from fats, and a higher intake of dietary fibre. Younger adults, compared to older ones, had statistically lower intakes of energy from fats, including saturated fats, and lower intakes of sodium chloride. Respondents with primary education, compared to those who had attained a higher degree of education, had a statistically lower intake of total energy and dietary fibre. Study showed that intakes of majority of nutrients in the diet of the adult Lithuanian population are not in compliance with the recommended daily intakes. Continuous nationally representative studies into food consumption and nutrient intake of the adult Lithuanian population must be carried out to assess the changes in the population’s diet and the effectiveness of policies aimed at promoting healthy diets.
The solicitation of nutrition-related health advice on social media platforms is on the rise. However, there is a paucity of research on the distinctive nutrition-related concerns and needs faced by transgender and gender-diverse individuals. Understanding patterns of nutrition-related information-seeking behaviour is vital to advancing health promotion efforts within this community. This study aimed to characterise the nutrition-related questions posed by the transgender community on a prominent social media outlet, Reddit.
Design:
A qualitative, cross-sectional content analysis was conducted, focusing on the top 100 submissions (ranked by popularity) within a transgender-centric online subreddit (r/asktransgender). Data extraction was facilitated using the Application Programming Interface Pushshift. The content analysis was conducted using NVivo.
Setting:
The study was situated within the discussion forum of the social media platform, Reddit.
Results:
A total of 148 references from 90 eligible posts were identified and coded. The major themes included the effects of hormone replacement therapy (HRT) on nutritional health (n 66), weight status (n 45), dietary needs and behaviours (n 21), physical activity and weight loss on body shape (n 9), social undermining (n 4) and effects of health behaviours on HRT (n 3).
Conclusion:
This study underscores the pressing need for tailored and evidence-based nutrition guidelines and communication toolkits that specifically address the distinct needs and experiences of transgender individuals, particularly those undergoing HRT.
Osteoarthritis (OA), a disease with a multifactorial aetiology and an enigmatic root cause, affects the quality of life of many elderly patients. Even though there are certain medications utilised to reduce the symptomatic effects, a reliable treatment method to reverse the disease is yet to be discovered. Zinc is a cofactor of over 3000 proteins and is the only metal found in all six classes of enzymes. We explored zinc’s effect on the immune system and the bones as OA affects both. We also discussed zinc-dependent enzymes, highlighting their significant role in the disease’s pathogenesis. It is important to note that both excessive and deficient zinc levels can negatively affect bone health and immune function, thereby exacerbating OA. The purpose of this review is to offer a better understanding of zinc’s impact on OA pathogenesis and to provide clarity regarding its beneficial and detrimental outcomes. We searched thoroughly systematic reviews, meta-analysis, review articles, research articles and randomised controlled trials to ensure a comprehensive review. In brief, using zinc supplementation in the treatment of OA may act as a doubled-edged sword, offering potential benefits but also posing risks.
To investigate how dieting is portrayed on TikTok and the potential implications for public health considering the effect of diet culture on eating disorders amongst young people.
Design:
A cross-sectional descriptive content analysis of 250 videos from the five most popular diet-related hashtags. A codebook was developed to analyse the content of the videos and collect the engagement for each video (likes, comments and shares).
Setting:
TikTok website.
Participants:
There were no participants in this study.
Results:
More than half of the videos portrayed ‘body checking’, a potentially harmful practice for body image. Of the videos that represented body image, almost half represented body image negatively. However, most videos promoted the idea of ‘healthy eating’, and only 6·4 % displayed disordered eating behaviours. Over half of the videos provided dietary advice, and of those videos, most content creators claimed to be experts (64 %). Claiming expertise was not significantly associated with engagement; however, the use of humour was significantly associated with engagement. Additionally, males were more likely than females to disclose their goals of the diet.
Conclusions:
Overall, it appears that TikTok is commonly used to share nutrition tips and personal experiences around dieting and eating in general, often employing humour as an effective technique. The popularity of the platform and rapid dissemination of information would be a useful tool for health professionals, especially those working with eating disorders, to utilise.
Food literacy (FL) is a potential approach to address the nutrition transition in Africa, but a validated tool is lacking. We developed and validated a scale to assess FL among Ugandan and Kenyan adult populations.
Design:
A mixed-method approach was applied: (1) item development using literature, expert and target group insights, (2) independent country-specific validation (content, construct, criterion and concurrent) and (3) synchronisation of the two country-specific FL-scales. Construct validity was evaluated against the prime dietary quality score (PDQS) and healthy eating self-efficacy scale (HEWSE).
Setting:
Urban Uganda and Kenya.
Participants:
Two cross-sectional cross-country surveys, adults >18 years (n = 214) and university students (n = 163), were conducted.
Results:
The initial development yielded a forty-eight-item FL-scale draft. In total, twenty-six items were reframed to fit the country contexts. Six items differed content-wise across the two FL-scales and were dropped for a synchronised East African FL-scale. Weighted kappa tests revealed no deviations in individuals’ FL when either the East African FL-scale or the country-specific FL-scales are used; 0·86 (95 % CI: 0·83, 0·89), Uganda and 0·86 (95 % CI: 0·84, 0·88), Kenya. The FL-scale showed good reliability (0·71 (95 % CI: 0·60, 0·79), Uganda; 0·78 (95 % CI: 0·69, 0·84), Kenya) and positively correlated with PDQS (r = 0·29 P = 0·003, Uganda; r = 0·26 P < 0·001, Kenya) and HEWSE (r = 0·32 P < 0·001, Uganda; r = 0·23, P = 0·017, Kenya). The FL-scale distinguishes populations with higher from those with lower FL (β = 14·54 (95 % CI: 10·27, 18·81), Uganda; β = 18·79 (95 % CI: 13·92, 23·68), Kenya).
Conclusion:
Provided culture-sensitive translation and adaptation are done, the scale may be used as a basis across East Africa.
The aim of this study is to assess nutritional status and associated factors among infants and young children aged 6–23 months in Yeka sub-city, Ethiopia, 2021. An institution-based cross-sectional study was conducted in selected health centres found in the Yeka sub-city from May 2021 to July 2021. In total, 396 systematically selected infants and young children aged 6–23 months attended the selected health centres were included in the study. Data were collected by using a structured questionnaire and anthropometric measurements. A multinomial logistic regression model was used.
The overall magnitude of undernutrition and overnutrition among infants and young children were 24.7% and 5.5%, respectively. Dietary diversity score (DDS) ((adjusted odd ratio (AOR) = 5.65; 95% CI = 2.301, 10.87; P value = 0.003), minimum meal frequency (MMF) (AOR = 5.435; 95% CI = 2.097, 11.09; P value = 0.0052), and diarrhoea (AOR = 2.52; 95% CI = 1.007, 6.310; P value = 0.002) were statistically significantly associated factors for nutritional status among infants and young children. Malnutrition (undernutrition and overnutrition) is a public health problem among infants and young children in Yeka sub-city, Ethiopia. DDS, MMF, and diarrhoeal disease were associated with higher odds of undernutrition.
Folate, vitamin B12, vitamin B6 and riboflavin interact by functioning as cofactors within one-carbon metabolism (OCM), a network of interrelated cellular pathways essential for numerous biological processes, including the biosynthesis of DNA, amino acid interconversions and methylation reactions. The pathways of OCM are influenced by endocrine signals and genetic polymorphisms and are particularly responsive to relevant B-vitamin intakes. Physiological changes in healthy pregnancy, leading to a steady decline in B-vitamin status, add another layer of complexity to the regulation of OCM. Although significant advances have been made to improve our understanding of these pregnancy-related changes, no specific reference ranges yet exist for B-vitamin biomarkers in pregnancy to support normal fetal growth without depleting maternal stores. The lack of pregnancy-related criteria for adequacy of B-vitamin status is in turn a major limitation in identifying pregnant women most at risk of B-vitamin deficiency. Another challenge is that the evidence is very limited to provide a basis for establishing pregnancy-specific dietary recommendations for B-vitamins to support successful pregnancy outcomes. In terms of preventing adverse outcomes, periconceptional folic acid supplementation has a proven role, established more than 30 years ago, in protecting against neural tube defect-affected pregnancies and this has been the major focus of public health policy worldwide. This review evaluates the emerging evidence for the less well recognised role of B-vitamins in preventing hypertensive disorders in pregnancy and the intergenerational effects of B-vitamins on offspring neurodevelopment and cognitive performance during childhood. We also consider the underlying biological mechanisms.
Prior research has shown that there are more supermarket displays of sugar-sweetened beverages (SSB) during times when Supplemental Nutrition Assistance Program (SNAP) benefits are distributed (‘issuance periods’). This may contribute to inequitable purchasing and consumption. This study examines whether SSB marketing in weekly supermarket circulars, which retailers use to advertise products, is more prevalent during issuance periods compared to non-issuance periods.
Design:
We conducted longitudinal, difference-in-differences analyses of data extracted from weekly supermarket circulars of randomly selected SNAP-authorised retailers in six states. Analyses tested whether SSB advertisements (‘ads’) were more prevalent during SNAP issuance periods compared to non-issuance periods within states with distinct issuance periods (3, 5, 10 or 15 d), compared to one state with continuous benefit issuance (28 d; the ‘control’ state).
Setting:
Weekly online supermarket circulars collected from August to September 2019 were analysed in 2021.
Participants:
The study sample included 5152 circulars from 563 SNAP-authorised retailers in the states California, Connecticut, Nebraska, New Jersey and Texas (distinct issuance period states) as well as Florida (‘control’ state).
Results:
The estimated mean percentage of beverage ads classified as SSB ads during issuance days was 51·5 % compared to 48·4 % during non-issuance days (P < 0·001). In difference-in-differences analyses comparing to the ‘control’ state with continuous issuance, SSB ad counts were 2·9 % higher (95 % CI 1·9 %, 3·9 %) during SNAP issuance relative to non-issuance.
Conclusions:
SSB ads are slightly more prevalent in weekly supermarket circulars during SNAP issuance periods. Future research should explore the linkages between circular ads and SSB purchasing and consumption.
Although the relationship between dyslipidaemia (DL) and coronary artery disease (CAD) or between trace minerals intake and CAD is well known separately, the exact nature of this relationship remains unknown. We hypothesize that the relationship between trace mineral intake and CAD may differ depending on whether or not the individual has DL. The present study analysed the relationships among trace mineral intake, DL, and CAD in middle-aged and older adults living in Shika town, Ishikawa prefecture, Japan. This study included 895 residents following the exclusion of those with genetic risk carriers for familial hypercholesterolemia. Trace mineral intake was evaluated using the brief-type self-administered diet history questionnaire. Interactions were observed between DL and CAD with zinc (p = 0.004), copper (p = 0.010), and manganese intake (p < 0.001) in a two-way analysis of covariance adjusted for covariates such as sex, age, body mass index, and current smokers and drinkers. Multiple logistic regression analysis showed that zinc (odds ratio (OR): 0.752; 95% confidence interval (CI): 0.606, 0.934; p = 0.010), copper (OR: 0.175; 95% CI: 0.042, 0.726; p = 0.016), and manganese (OR: 0.494; 95% CI: 0.291, 0.839; p = 0.009) were significant independent variables for CAD in the dyslipidaemic group. The present results suggest that DL with a low trace mineral intake is associated with CAD. Further longitudinal studies are required to confirm this relationship.
Previous investigations on protein associations with diet quality and obesity still have inconclusive findings, possibly due to how protein intake was expressed. This study aimed to compare how different ways of expressing total protein intake may influence its relationships with diet quality and obesity. Usual protein intake was estimated from the 2011–12 Australian National Nutrition and Physical Activity Survey (n = 7637 adults, ≥19 years), expressed in grams (g/d), percent energy (%EI), and grams per actual kilogram body weight (g/kgBW/d). Diet quality was assessed using the 2013 Dietary Guidelines Index, and obesity measures included Body Mass Index (BMI) and waist circumference (WC). Sex-stratified multiple linear and logistic regressions were performed and adjusted for potential confounders. Total protein (g/d) was directly associated with diet quality (males, β = 0.15 (95% CI 0.12, 0.19); females, β = 0.25 (0.22, 0.29)), and this association was consistent across units. Protein intake (g/d) was directly associated with BMI (males, β = 0.07% (0.04%, 0.11%); females, β = 0.09% (0.04%, 0.15%)), and WC (males, β = 0.04 (0.01, 0.06); females, β = 0.05 (0.00, 0.09)). While in males, protein as %EI was associated with higher WC, no association was found in females. Adults with higher protein intake (g/d) had higher odds of overweight/obesity (males, OR = 1.01 (1.00, 1.01); females, OR = 1.01 (1.00, 1.01)), and central overweight/obesity (females, OR = 1.01 (1.00, 1.01)), but no significant association with females odds of overweight/obesity when protein was expressed in %EI. In conclusion, protein intake was positively associated with diet quality and obesity, yet these associations were stronger for women. The effect sizes also varied by measurement unit due to the different scales of those units.
Ruminal microbes catabolise feed carbohydrates mainly into SCFA, methane (CH4), and carbon dioxide (CO2), with predictable relationships between fermentation end products and net microbial increase. We used a closed in vitro batch culture system, incubating grass and maize silages, and measured total gas production at 8 and 24 h, as well as the truly degraded substrate, the net production of SCFA, CH4, and microbial biomass at 24 h, and investigated the impact of silage type and inoculum microbial mass on fermentation direction. Net microbial yield was negatively correlated with total gas at 8 h (P < 0•001), but not at 24 h (P = 0•052), and negatively correlated with CH4 production (P < 0•001). Higher initial inoculum microbial mass was related to a lower net microbial yield (P < 0•001) but a higher CH4 production (P < 0•001). A significant difference between grass silage and maize silage was detected within the context of these relationships (P < 0•050). The metabolic hydrogen (2H) recovery was 102.8 ± 12.3 % for grass silages and 118.8 ± 13.3% for maize silages. Overall, grass silages favoured more substrate conversion to microbial biomass and less to fermentation end products than maize silage. Lower inoculum microbial mass facilitated more microbial growth and, because of the 2H sink by microbial synthesis, decreased CH4 production.
This study aims to develop a nutrition education intervention to promote healthy eating, and to evaluate the effectiveness of this intervention on healthy eating knowledge, attitude and behaviour among elementary students. A quasi-experimental study was conducted in two elementary schools in Taiwan. The intervention course design included simulation videos, lectures, and the after-school learning worksheet designed for parental involvement. A total of 4 courses along with 4 simulation videos were given to the intervention group. The four course themes were Sugar patrol, Balanced Diet during the Mid-Autumn Festival, Rainbow Fruit and Vegetables, and Smart Dine Out. The study recruited 35 3rd grade students for the intervention group and 30 for the control group. Data were collected from the pre- and post-test questionnaires. The nutrition intervention had significant effects on improving participants’ knowledge about tips for making healthy choices and the necessity of balanced diet, and on attitude toward healthy eating. There was no significant improvement in participants’ healthy eating behaviours. This nutrition education intervention, which utilized simulation videos and encouraged parental involvement, could be recommended for teaching practice in elementary schools to improve healthy eating knowledge and attitude among students.
Sodium intake attributed to fast food is increasing globally. This research aims to develop maximum sodium reduction targets for New Zealand (NZ) fast foods and compare them with the current sodium content of products. Sodium content and serving size data were sourced from an existing database of major NZ fast-food chains. Target development followed a step-by-step process, informed by international targets and serving sizes, and previous methods for packaged supermarket foods. Sodium reduction targets were set per 100 g and serving, using a 40% reduction in the mean sodium content or the value met by 35–45% of products. Thirty-four per cent (1797/5246) of products in the database had sodium data available for target development. Sodium reduction targets were developed for 17 fast-food categories. Per 100 g targets ranged from 158 mg for ‘Other salads’ to 665 mg for ‘Mayonnaise and dressings’. Per serving targets ranged from 118 mg for ‘Sauce’ to 1270 mg for ‘Burgers with cured meat’. The largest difference between the current mean sodium content and corresponding target was for ‘Other salads’ and ‘Grilled Chicken’ (both –40% per 100g) and ‘Fries and potato products’ (–45% per serving), and the smallest, ‘Pizza with cured meat toppings’ (–3% per 100 g) and ‘Pies, tarts, sausage rolls and quiches’ (–4% per serving). The results indicate the display of nutrition information should be mandated and there is considerable room for sodium reduction in NZ fast foods. The methods described provide a model for other countries to develop country-specific, fast-food sodium reduction targets.
The prevalence of food insecurity in Cyprus and the socio-demographic factors that are related to this public health problem are unknown. Data used in this cross-sectional study were collected between 1 June 2022 and 21 May 2023 using a self-reported method. Food insecurity was evaluated using the Greek version of Adult Food Security Survey Module. The data regarding socio-demographic and socio-economic characteristics along with body weight and height measurements were collected through self-administered questionnaire. A representative sample of n=1255 adults, ≥18 years old living in the five different districts of the Republic of Cyprus, was recruited. Prevalence of food insecurity in Cypriot population was 12.6%. Prevalence was higher in females, in older adults, in adults living in Paphos, in individuals who were separated, divorced, or widowed, in retired people, in people living with children, and in people with low income and education. Based on multivariable analysis, income was the strongest socio-demographic factor independently associated with food security (€ 6,500–€ 19,500: AOR: 0.49, 95% CI 0.28, 0.86 and >€ 19,500: AOR: 0.15, 95% CI 0.73, 0.31). Food insecurity is a global problem that need further examination. The association between food insecurity and socio-demographic characteristics needs to be highlighted in order for each country to develop specific public health policies (e.g. financial support to low income people) to decrease food insecurity and improve people’s overall health and quality of life.
The current study aims to characterise the complementary feeding practice and identify locally available climate-resilient crops that can be used for complementary feeding among agro-pastoralists in Ethiopia. A phenomenological study in Benna-Tsemay district, comprising focused group discussions, key informant interviews, and household observations, was conducted. A pretested guide was used to capture information regarding types of complementary food, lists of food items, and ingredients included in their complementary formulation. A thematic analysis for emerging points of discussion was carried out. Three major themes, including infant and young child feeding practices, food items included in complementary food, and their consumption frequencies, as well as the incorporation of climate-resilient crops into complementary foods as coping mechanisms, emerged. Breastfeeding was common and regarded as essential. Gruel and porridge from grains, roots, and tubers were regular parts of complementary foods in the study area. Moringa and sorghum were dominantly identified as climate-resilient crops regularly grown and used in complementary foods. Growing these crops was regarded as a coping strategy for drought and seasonal constraints. The district is one of the most drought-prone areas in Ethiopia, compromising the quality of complementary food. Unlike the World Health Organization recommendation, the grains, roots, and tubers-based diet formed the basis of complementary food lacking flesh foods, eggs, pulses, and other fruits and vegetables. Thus, it is recommended to improve complementary food quality through value-addition using locally accessible crops.