Presented by

Joycelyn Adinkrah Faculty of Life Sciences

Assessment of dietary intake and body composition among first generation

migrant Ghanaians living in London

African and Afro-Caribbean migrants have a higher prevalence of obesity, diabetes and hypertension than the host population.

Dietary and anthropometric for this population are limited primarily because of the difficulty of access.

UK Ghanaians one of the largest ethnic groups now living in London.

It is estimated that the majority of first generation West African migrants in UK are Christian and attend Church.

The Church has been used successfully in the USA as a setting to deliver nutrition interventions.

Introduction

This study was designed to characterise the habitual dietary intake and anthropometry of Ghanaian migrants in London.

To use anthropometric data to assess prevalence of overweight and obesity in migrant Ghanaians in London.

To develop a nutrition education program specific for Ghanaian migrants in the UK.

To assess the efficacy of the nutrition education program through the Black Churches in the UK.

Aims of the study

The study was a cross-sectional study that recruited 18-65 year old first generation Ghanaian migrants in the UK and Ghana.

London - known to have a high population of Ghanaian migrants was used as the catchment area for the study in the UK.

Four black majority churches in London agreed to participate in the study and two hundred and twelve volunteers (n=212) were interviewed face-to-face.

A sample of eighty (n=80) participants were also recruited from two local churches in Accra (urban) and Kasoa (rural), Ghana.

Recruitment

Dietary data was collected using a semi-quantitative food frequency questionnaire (FFQ) which was validated using repeated 24 hour recalls and 7 day records in a sub-sample of the population.

Anthropometric indices of height, weight, waist and hip circumference was obtained as well as percentage body fat.

A questionnaire was also developed to collect information on age, gender, country of birth, marital status, occupation, and level of education, physical activity, potential confounders and other relevant lifestyle factors.

Methodology

Three focus group interviews were held with a sample of the study participants in both London and Ghana to find out their perceived and ideal body shapes and sizes using the Figure Rating Scale below.

Focus Groups

Sociodemography The population sample (n=212) was similar in terms of housing and

employment to that reported in the 2001 census for England.

About 84% were found to have had either a secondary or tertiary education.

Dietary Intake

Validation of the FFQ with repeated multiple 24hr recalls showed good agreement for energy (r=0.8), protein (r=0.61), fat (r=0.87), and carbohydrate (r=0.71)

Population characteristics

Current study *NDNS (2004) **Afro-Caribbeans in UK

Nutrients Males (n=88) Females (n=124) Males Females Males Females

Energy (kcal) 2290 1852 2313 1632 2166 1853

Protein (g) 83 (14.5%) 71 (15.3%) 88.2 (16.5%) 63.7 (16.6%) 104 (14.6%) 67.7 (14.7%)

Fat (g) 86 (33.9%) 75 (36.5%) 86.5 (35.8%) 61.4 (34.9%) 79.7(31.2%) 66.9 (31.5%)

Carbohydrate (g) 296 (51.6%) 223 (48.2%) 275 (47.7%) 203 (48.5%) 304 (51.2%) 296 (31.5%)

Fibre (g) 18 17 15.2 12.6 24.9 22.4

Vitamin C (mg) 67 79 83.4 81.0

Vitamin E (mg) 10 9 10.6 8.1

Sodium (mg) 3138 2800 3313 2302

Iron (mg) 12 11 13.2 10.6

Vitamin B12 (µg) 6 4 6.5 4.8

Table 1: Dietary intake of Ghanaian migrants in London

* NDNS National Diet and Nutrition Survey** Sharma et al, 1998

Prevalence of overweight and obesity in Ghanaian migrants in London

The idea that Ghanaian men preferred women who were overweight was found not consistent with our findings from focus groups conducted in Ghana and London.

For health reasons, first generation Ghanaians wanted to have smaller body sizes whereas native Ghanaians wanted to be slim to look more beautiful and also to be accepted in the society.

The majority of overweight and obese Ghanaian women in London were receptive to the proposal of a six week nutrition education programme to be delivered through their Church.

Cultural perceptions on body image

In collaboration with Prof McCarthy’s London Metropolitan weight management programme a nutrition education program is being developed specific for UK Ghanaians.

Topics will include• Portion sizes, Food labelling • Getting active, Setting realistic Weight loss goals, Keeping motivated

and Maintaining your weight• Planning your meals/Shopping, Hunger strategies and Eating out• Decreasing your Salt/Sodium intake, Fat intake, Alcohol and Drinks and

Hidden calories

In terms of public health, this will be a useful way to promote weight loss, modify health behaviours and also serve as a platform to launch nutrition intervention programs for all West Africans in the United Kingdom.

Further work

Agyemang, C., Owusu-Dabo, E., de Jonge, A., Martins, D., Ogedgbe, G. & Stronks, K. (2008). Overweight and obesity among Ghanaian residents in The Netherlands: how do they weigh against their urban and rural counterparts in Ghana, Public Health Nutrition, 12(7): 909-916.

Amoah, A.G. (2003). Obesity in adult residents of Accra, Ghana. Ethn Dis., 13(2 Supp 12):S97–S101.

Bays, H.E., Bazata, D.D., Fox, K.M., Gandy, S., Gavin, III J.R. and Shield Study Group. (2009). Perceived body image in men and women with type 2 diabetes mellitus: correlation of BMI with figure rating scale. Nutr. Journal, 8:57.

London Health Observatory. (2007). Population Groups- Ethnic Minorities London, LHO.

Mackintosh, M. (2005) London – the world in a city: an analysis of 2001 Census results. Data Management and Analysis Group Briefing 2005/6.

Office for National Statistics (2002). Census 2001- Ethnicity and Religion in England and Wales. ONS: London

Wagner, D.R. & Heyward, V.H. (2000). Measures of body composition in blacks and whites: a comparative review. American Journal of Clinical Nutrition, 71:1392-1402.

References