The Promotion and Consumption of Local Foods in SIDS: A Dietary Intervention

Project: The promotion and consumption of local foods in a Small Island Developing State (SIDS): A dietary intervention

Supervisor: Professor Simon Anderson

Local Project Investigator: Dr. Madhuvanti Murphy

Program: PhD Public Health (UWI Faculty of Medical Sciences)

This PhD is part of a larger project supported by a UK Research and Innovation grant through the Biotechnology and Biological Sciences Research Council (UKRI-BBRSC), and Global Challenges Research Fund. The larger project aims to design, implement and evaluate a community food production intervention (home gardens) in SIDS such as St. Vincent and the Grenadines (SVG), Fiji and Haiti. However, this PhD focuses on SVG, a middle-income Caribbean country.  Prior to the creation of the intervention, a stakeholder meeting will be kept to further discuss and design the intervention. Decisions will be influenced by results gained from reviewing similar projects.

The aim of this project is to co-design and evaluate a community-level home garden intervention focused on improving household nutrition, while the overarching goal is to inform and influence food policies within other SIDS as well as the Caribbean. To achieve this the project is broken down into two sections: Intervention uptake and Food consumption.

Intervention Uptake: 1-Assessment of the intervention’s impact on dietary quality and diversity through 24 hour recalls, an adapted country specific food frequency questionnaire and pre-validated tools (Minimum Dietary Diversity for Women of Reproductive Age (M-DDW) and the Infant and Young Children Feeding Minimum Dietary Diversity (IYCF MDD)). 2- Assessment of food insecurity via the use of the FAO’s culture sensitive Food Insecurity Experience Scale (FIES). Food Consumption: 1- Identification of changes related to metabolic non-communicable disease (NCD) risk factors (baseline and follow-up measures of blood pressure, central adiposity, cholesterol, blood glucose). 2- Assessment of micronutrient status (baseline and follow-up measures of sodium, iron, calcium etc.). (Figure 1). 3- Identification of dietary patterns or practices affected by COVID.

Justification

Within the past decades, environmental and economic alterations have led to food insecurity patterns in the Caribbean. There has been a regional decrease in agricultural practices and a subsequent dependence on foods supplied by international companies, particularly within the U.S. This has caused a nutritional shift which has been compounded by changes within the built environment discouraging physical activity. As a result, there has been a rapid increase in overweight and obesity (BMI>25) leading to NCDs such as diabetes, cardiovascular disease and cancer. It has also increased the number of micronutrient deficiencies such as iron deficiency anaemia, in some countries. The large dependence on imported foods has increased accessibility through affordable processed and ultra-processed foods high in unnatural sugars, sodium and saturated fats. This has led to a decrease in foods traditionally consumed such as tubers, vegetables, legumes and fruits.

Though, the World Health Organization (WHO) recommends that adults should consume five portions of fruit and vegetables per day and that a healthful diet includes fruit, vegetables, legumes, nuts and whole grains that are unprocessed and unrefined. Less than 15% of most Caribbean men and women eat the recommended five portions of fruit and vegetables daily. Recent COVID related national non-pharmaceutical interventions and policies such as food-shopping restrictions have heightened the population’s dependence on calorie dense or energy dense ready to eat and convenient foods. This suggests that there may be a further reduction in healthful dietary practices, regionally. Moreover, this creates additional challenges for persons with pre-existing diet related chronic diseases.

The WHO also advises that less than 10% of total energy intake should be derived from free sugars, less than 30% should be derived from fats, and less than 5 grams of sodium should be consumed daily. However, studies confirm that fat, sugars and sodium have been consumed excessively beyond recommended upper limits.

Apart from national responses such as SVG’s Coronavirus Food Security and Impact Mitigation Plan , these challenges have led to rapid responses from international and regional heads and bodies such as the Caribbean Public Health Agency (CARPHA), the WHO and the Pan American Health Organization. A document of particular relevance was the joint statement created by the Healthy Caribbean Coalition (HCC) and the Organisation of Eastern Caribbean States (OECS) Commission, on strengthening food and nutrition security. This document reiterated the importance of producing local nutritious foods, revealing home gardening as an easy and logical mean. Follow up HCC articles have also covered tips and guidelines to creating home gardens.

Internationally, community based agricultural interventions such as the provision of seed, plants and training to increase home garden fruit and vegetable production have created positive impacts on dietary quality and diversity including the reduced odds of both obesity and anaemia. However, to date there has only been small home garden interventions within the Caribbean with very little evaluations and outcomes. Hence, there is a need to design larger community home garden interventions and thoroughly assess its impact on diet and health. As such this project aims to implement 150 -200 home gardens within one community in SVG and randomly choose 150-200 with no implemented home gardens to fully assess and compare the impact of implementing home gardens on diet and health.