DIETARY PATTERNS IN UGANDA AND THEIR INFLUENCING FACTORS: A CRITICAL REVIEW

Improving the understanding of dietary patterns and underlying factors remains crucial in designing nutritional interventions and policy making. This review sought to provide a holistic picture of the studies covering dietary patterns in Uganda and the associated factors so as to identify gaps in existing literature and provide a basis for nutrition-sensitive interventions. A literature search for publications dating from March 2010 to 2021 was done using the terms dietary diversity, nutrient intake, food consumption and food choices in Uganda. Studies covering populations above 6 months of age, male and female, with exception of diseased populations, were screened. Because of the variability in the methodologies for assessment of dietary intake and dietary diversity, meta-analysis was not conducted. A total of 17,728 articles were found and 25 studies met the inclusion criteria. Nine of the 25 studies reported on dietary diversity indicators and their associated factors. The literature shows that diets in Uganda are mainly composed of starchy staples, especially cereals, roots, tubers and bananas, with legumes constituting the main protein source. The diets are characterized by low consumption of fruits and vegetables as well as animal protein sources. The share of food expenditure allocated to the different food groups corresponded to information on consumption for the different groups. Studies revealed that household food expenditure was higher among urban households, an observation attributable to their high reliance on food purchases to meet food requirements. The share of household expenditure on cereals and staples was reported to decrease with increasing wealth quantile and was lower among urban households. An opposite trend was reported for animal protein sources. Across the different studies, the mean dietary diversity score was above three (3). Nonetheless, intake of micronutrients and the mean dietary energy consumption (DEC) were reported to be lower than the daily recommended values. Given the lack of uniformity in the indicators across the different studies and differences in methodologies especially for dietary diversity scores, the existing research is inadequate for establishing quantitative evidence on the trends in dietary patterns and diversity, gender and age group differences in relation to dietary patterns. There is a need for highquality, nation-wide research using validated tools and methodologies to measure dietary patterns and trends and explore the relation to gender and age groups.

深化对膳食模式及其潜在影响因素的认知，对于制定营养干预方案与公共政策仍具有关键意义。本综述旨在全面梳理乌干达地区有关膳食模式及其相关影响因素的研究，以明确现有文献的研究空白，并为制定营养敏感型干预措施提供依据。本研究以“乌干达、膳食多样性、营养素摄入、食物消费与食物选择”为检索词，对2010年3月至2021年期间发表的文献进行了系统检索。筛选纳入对象为6个月以上、不分性别的人群，但排除患病群体。由于膳食摄入与膳食多样性评估方法存在异质性，本综述未开展荟萃分析（meta-analysis）。最终检索得到17728篇文献，其中25项研究符合纳入标准。25项研究中，有9项针对膳食多样性指标及其相关影响因素进行了报道。现有文献显示，乌干达居民的膳食主要以富含淀粉的主食为主，尤以谷物、根茎类作物及香蕉为代表，豆类是主要的蛋白质来源。其膳食结构普遍存在水果、蔬菜及动物源蛋白质摄入不足的问题。不同食物类别的食品支出占比与对应类别的食物消费数据相符。研究表明，城镇家庭的食品支出水平更高，这一现象源于城镇家庭更依赖外购食品以满足膳食需求。研究发现，家庭食品支出中谷物与主食的占比会随财富分位提升而下降，且城镇家庭的该占比更低。动物源蛋白质的消费占比则呈现相反的变化趋势。多项研究的平均膳食多样性得分均高于3分。不过，现有研究显示，居民的微量营养素摄入与平均膳食能量摄入（dietary energy consumption, DEC）均低于每日推荐摄入量。由于不同研究间的膳食多样性评估指标不统一，且评估方法存在差异，现有研究无法为膳食模式与多样性的变化趋势、膳食模式相关的性别与年龄群体差异提供量化证据支撑。因此，亟需采用经过验证的工具与方法开展全国性高质量研究，以评估膳食模式及其变化趋势，并探究其与性别、年龄群体的关联。