Adolescents’ diet

Diet questions were based on the Minimum Dietary Diversity Score for Women produced by the Food and Agriculture Organization and USAID’s Food and Nutrition Technical Assistance III Project (FANTA), which is used to primarily derive a diet diversity score (DDS) as an indicator of dietary macro- and micronutrient adequacy⁽⁷⁾. It has questions about fourteen mutually exclusive food groups: (1) grains, (2) vegetables or roots that are orange-coloured inside, (3) white roots and tubers or plantains, (4) dark green leafy vegetables, (5) fruits that are dark yellow or orange inside, (6) any other vegetables, (7) any other fruits, (8) meat made from animal organs, (9) meat and poultry, (10) eggs, (11) fish or seafood (fresh or dried), (12) beans, peas or lentils, (13) nuts or seeds, (14) milk or milk products. As recommended in the use of this questionnaire⁽⁷⁾, teams were asked to select foods eaten by their population as examples, and to record whether adolescents had eaten foods in each group within the past 24 h. We additionally asked how often they ate foods in each group (‘every day’, 5–6 times per week, 2–4 times per week, once a week, or less than once a week, including never).

We also asked about snack and ‘fast’ foods, using the same two questions: (1) fried snacks, (2) savoury snacks in packets, (3) bakery items (e.g. cakes/biscuits/puffs), (4) sweets, (5) fast food/street food/restaurant food and (6) fizzy drinks (sugar-sweetened beverages). ‘Restaurant food’ was the term thought to be most understandable to participants to capture eating meals cooked in a café/restaurant setting, sometimes as takeaway food to eat at home, which tends to be high in fat or sugar. These snack and fast foods did not contribute to the DDS.