Dietary diversity and its association with nutritional status of adults at risk of diabetes and the nutrient density and cost of foods

Abstract

Background: South Africa has a high prevalence of non-communicable diseases (NCDs), with a triple burden of malnutrition, which includes childhood under- and over-nutrition, micronutrient deficiencies, and overweight and obesity among adults. The current nutrition transition, in combination with high unemployment rates, low household incomes and rising food prices, has contributed to unhealthy diets, malnutrition and NCDs in South Africa. Dietary diversity (DD), a measure of nutrient adequacy promoted globally through food-based dietary guidelines (FBDGs), is low in South African adults. Data on the association of DD with an intake of unhealthy foods and cardiometabolic risk factors for NCDs, including type 2 diabetes mellitus (T2DM) in the South African context, is limited. In addition, data are lacking on the barriers and enablers of consuming a diverse diet. South Africans with lower incomes may have difficulty adhering to the FBDGs because of high food costs. Nutrient profiling models, such as the Nutrient Rich Food Index (NRF9.3) in combination with food prices, can assist in identifying nutritious and affordable foods.