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«Minimum Dietary Diversity for Women A Guide to Measurement Minimum Dietary Diversity for Women A Guide to Measurement Published by the Food and ...»

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There are two issues in determining items to list as examples of seeds in row D of the questionnaire:

the definition of seeds and the usual amount consumed.

In the botanical sense, seeds include a very broad range of items, including nuts, grains and legumes.

But in culinary systems, there are usually a limited number of other seeds (i.e. not considered as nuts, grains or legumes), which are typically high in fat content and consumed as snacks or side dishes, in pastes, to season or garnish mixed dishes or to chew as a digestive.

For the purposes of this guide, the culinary definition of “seeds” excludes tree nuts, grains and legumes. A very wide range of seeds are foraged or cultivated and used in cuisines in many regions.

It is not possible to provide a comprehensive list of seeds used as foods; the table above provides examples.

Because they are often consumed in very small quantities, most seeds should be listed on the questionnaire among the examples in the “Condiments and seasonings” row (category “U”, below) of the questionnaire, not in the “Nuts and seeds” group, and enumerators should mark consumption in category “U”.

However, seeds may be listed as examples in row D, “Nuts and seeds”, if it is known that they are usually added as a substantial ingredient in local mixed dishes or if they are usually eaten as a substantial snack or side dish (see Box 1 on page 13 for more detailed discussion of quantities). If there is uncertainty about quantities usually consumed, seeds should be classified with “Condiments and seasonings” to avoid inflating the proportion of women reported to consume this nutrient-dense food group.

The decision on where to place various types of seeds (and their products) on the questionnaire should be made during questionnaire adaptation.

E. Milk and milk products This group includes almost all liquid and solid dairy products from cows, goats, buffalo, sheep or camels.

Milk and dairy products are often used as ingredients in mixed dishes or are added to other beverages. See Boxes 1 and 3 (pages 13 and 21) for a discussion of ingredients used in mixed dishes.

When milk or dairy products are added to mixed dishes, often the amount of dairy consumed in a serving of the mixed dish is small. Decisions on how to classify milk added in mixed dishes should be made during questionnaire adaptation. If there is uncertainty about quantities usually consumed, milk/dairy ingredients should not be classified in the “Milk and milk products” group (group “E”) to avoid inflating the proportion of women reported to consume the nutrient-dense dairy group. Unless nutritionists involved in adaptation advise otherwise, classify as indicated here.

Items in this group include:

• Fresh whole, low-fat and skim milk when drunk/consumed as such • Reconstituted powdered or evaporated milk or ultra-high temperature (UHT) (boxed) milk consumed as such • Hard cheese (e.g. cheddar, mozzarella, Swiss, parmesan) • Soft cheese (e.g. ricotta, cottage, paneer) • Kefir • Yoghurt/curd

Items not included in this group and classified into other categories:

• Butter, cream and sour cream: Classify with “Other oils and fats” (category “Q”) because of their high fat content and most typical culinary uses.

52 Appendix 2

• Cocoa drinks with milk: Classify with “Sugar-sweetened beverages” (category “T”).

• Ice cream: Classify with “Sweets” (category “S”).

• Processed/packaged yoghurt drinks: Classify with “Sugar-sweetened beverages” (category “T”), because these are usually high in sugar and low in dairy content.

• Sweetened condensed milk: Classify with “Sweets” (category “S”) if used as a food ingredient and with “Sugar-sweetened beverages” (category “T”) if diluted and consumed as a beverage.

• Tea or coffee with milk: Classify with “Other beverages and foods” (category “V”) if unsweetened and with “Sugar-sweetened beverages” (category “T”) if taken with sugar.

Note: The next three groups are separated into three rows on the questionnaire but are combined into one group for calculation of the MDD-W indicator.

F. Organ meat This group includes different types of red organ meats that are usually rich in iron. Because of their high iron content, blood sausage and other blood products are also included.

• Blood sausage, other blood products • Gizzard • Heart • Kidney • Liver Pale organ meats, such as tripe, are not included because the iron content is far lower. Tripe and other pale organ meat can be classified with “Meat and poultry” (group “G”).

G. Meat and poultry All flesh meats from mammals, birds, reptiles and amphibians are included. Processed meats are also included.

• Beef, goat, lamb, mutton, pork, rabbit, yak, deer, antelope, buffalo or other large wild (bush meat) or domesticated mammals • Tripe or other pale organ meats • Cane rat, guinea pig, rat, agouti, opossum, cat, dog, anteater or other small wild (bush meat) or domesticated mammals • Chicken, duck, goose, guinea fowl, turkey, pigeon or other wild or domesticated birds • Crocodile, frog, snake and other reptiles and amphibians There is increasing interest in and concern regarding consumption of red meat and processed meats (see, for example, Bouvard et al., 2015, and http://www.who.int/features/qa/cancer-red-meat/en/).

In some settings, consumption of animal-source foods is very low, while in others it is consumed in excess of needs.

For the purposes of the MDD-W indicator, all flesh foods, including red meat and processed meat, are included in this group. However, in settings where there are public health concerns about excessive consumption and/or where processed meats are widely consumed, an additional row could be added to the questionnaire to disaggregate and capture descriptive information about specific types of meat of concern, i.e. to separate red meat and/or processed meat from other flesh foods.

53 Appendix 2

H. Fish and seafood This group includes fish and seafood from both marine and freshwater environments.

• Fresh, frozen or dried fish, large or small, all species • Canned fish (e.g. anchovies, tuna and sardines) • Clams, mussels, oysters and scallops (bivalves) • Shrimp, lobster, crayfish and crabs (crustaceans) • Edible sea urchins and sea cucumbers (echinoderms) • Octopus, squid and cuttlefish • Shark • Whale Fish roe and snails are not included and are classified with “Insects and other small protein foods” (category “O”).

I. Eggs This group includes all kinds of bird eggs.

• Chicken eggs • Duck eggs • Guinea fowl eggs • Quail eggs J. Dark green leafy vegetables Essentially all medium-to-dark green leafy vegetables are vitamin A-rich (see Box 2 on page 15 for criteria for classifying items as vitamin A-rich). Only very light leaves, such as iceberg lettuce, are not.

Commonly consumed leaves include many wild and foraged species, as well as the green leaves of food crops. In the absence of information on nutrient content, wild/foraged leaves that are mediumto-dark green can be assumed to be vitamin A-rich and placed in this group.

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Note: The next two groups (“Vitamin A-rich vegetables, roots and tubers” and “Vitamin A-rich fruits”) are separated into two rows on the questionnaire but are combined into one group for calculation of the MDD-W indicator.

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L. Vitamin A-rich fruits In addition to the examples in the table below, include any other locally available dark yellow or orange fruits that are sources of vitamin A (see Box 2).

Note: Certain fruits (e.g. mango and papaya) are high in vitamin A when ripe, but not when eaten “green” or unripe. When they are eaten “green” (unripe), mango and papaya should be classified with “Other fruits” (group “N”). If appropriate, these fruits should be listed as “ripe” in this row of the questionnaire and as “green” in the “Other fruits” row. In this situation, enumerators should be trained on this point.

Certain varieties of ripe, deep yellow- or orange-fleshed bananas are also rich in vitamin A, but white/cream-fleshed bananas are not. Deep yellow- and orange-fleshed bananas may be classified with vitamin A-rich fruits when their high vitamin A content is known to survey planners and it is considered feasible to distinguish bananas by colour during fieldwork. Otherwise, all bananas should be classified with “Other fruits” (group “N”), to avoid inflating the proportion of women reported to consume vitamin A-rich foods.

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M. Other vegetables In general, the “Other vegetables” group follows the culinary definition of a vegetable and not the botanical definition. It includes stems, fruits and flowers of plants when generally consumed in savoury dishes and considered as vegetables in culinary systems. So, for example, cucumber, tomato and okra (all fruits in botanical terms) are included as “Other vegetables”.

This group includes legumes when the fresh/green pod is consumed (as in fresh peas, snow peas, snap peas or green beans).

This group does not include high-carbohydrate “starchy” roots and tubers, such as white potatoes, white yams, cassava and cocoyam, which are classified in the “White roots and tubers and plantains” group (group “B”).

As with dark green leafy vegetables, commonly consumed vegetables vary widely with geography and can include foraged as well as cultivated foods. The following table provides a long list of examples, but other local vegetables can also be classified in this group.

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Various varieties of young bean pods are eaten as vegetables; please refer to the “Pulses (beans, peas and lentils)” group (group “C”) a for a list of many varieties. All the varieties of bean consumed as a young pod should be included in this category. When only mature seeds are eaten (fresh or dried), they should be listed under group “C”.

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Note: The next six categories are optional food categories. A decision on including these categories should be taken by survey designers early in the adaptation process (see Section 4).

O. Insects and other small protein foods This group includes a very wide variety of insects and other small protein foods. With an estimate of more than 2,000 insect species alone (Rumpold and Schlüter, 2013), it is not possible to provide a comprehensive list.

Items in this group include:

• Fish roe • Insects • Insect eggs • Insect larvae/grubs • Snails • Spiders • Any other small invertebrates This category does not include frogs, snakes or other reptiles and amphibians, which are included in the “Meat and poultry” group (group “G”).

If these foods are not eaten or are considered very rare throughout the survey area, this category does not need to be included on the questionnaire.

59 Appendix 2

P. Red palm oil This category includes only red palm oil, which is usually consumed as an ingredient in mixed dishes.

Note that the oily red palm fruit is classified with “Vitamin A-rich fruits” (group “L”). In areas where grown, the oil and/or the oily fruit may be consumed, depending on the particular mixed dish.

If red palm oil is not available, not consumed or considered very rare throughout the survey area, this category does not need to be included on the questionnaire.

Q. Other oils and fats This category includes all solid and liquid oils and fats other than red palm oil, including those of

plant or animal origin:

• Butter • Cream • Ghee • Lard, suet, tallow (animal fats) • Margarine, shortening (hydrogenated vegetable oil) • Mayonnaise • Palm oil (not red palm oil) • Sour cream • Vegetable/fruit/nut/seed oils (e.g. oils made from canola, coconut, cottonseed, groundnut, maize, olives, rapeseed, safflower, sesame, soybean, sunflowers and walnuts) • Any other oil extracted from a nut, seed or grain Note: In many surveys, some or all of the respondents will not know the type of oil consumed.

Labelling is insufficient and/or oils are locally produced, unlabelled or repackaged into unlabelled container or sachets. Oils can still be classified into this category as “Other oil or fat”.

R. Savoury and fried snacks This optional category will include different foods in different settings. There is currently no consensus and no standard approach to data collection on this category of food. However, there is growing interest in gathering information on nutrient-poor and/or energy-dense foods that are often consumed as snacks. This category includes highly processed commercial products but also a variety of processed “street foods”.

Examples include:

• Cassava chips, fried cassava balls, other cassava-based fried snacks • Corn/maize chips/fried tortilla strips • Crisps • Potato chips • Sweet potato chips • Puffs (cheese puffs, corn/maize puffs, other “puffs”) • Doughnuts/fried dough/“fry bread” • Samosas • Other deep-fried, mainly carbohydrate, snack foods Note: Some of these items (e.g. samosas) may include small amounts of meat or vegetables but are high in fat and simple carbohydrate and often may be high in sodium as well.

Other fried foods, such as fried potatoes and fried plantains, which may be consumed as meals or snacks, are classified with roots and tubers (group “B”) because in some settings potatoes or 60 Appendix 2 plantains are staple foods and classifying them with snacks might mean there would be no staple food in the count. This could result in a false “deflation” of food group diversity. Depending on their role in local diets, survey objectives and the likelihood of this false deflation, survey designers could choose to also classify fried potatoes, fried plantains and similar food in the “Savoury and fried snacks” category.

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