Wearable camera-based dietary assessment of mother-father dyads in urban and rural households in Ghana

Background: There is a dearth of studies examining the dietary intakes of parents from low-and middle-income countries (LMICs), which are foundational for understanding household-level double burden of malnutrition (DBM).Objective: To assess the energy and nutrient intakes (carbohydrates, protein, fat, vitamin A, folate, zinc, and iron) of mother-father dyads from rural and urban households in Ghana using a wearable camera, an objective measure of dietary intake, not subject to self-reporting errors. Methods:In this cross-sectional study, purposive convenience sampling was used to recruit 60 households with a mother, father, and a child under five and/or an adolescent from one rural and one urban community in Ghana.Both parents wore the Automatic Ingestion Monitor (AIM-2) over two weekdays and one weekend day.Dietary intake was analyzed using custom AIM annotation software.Household characteristics were collected via questionnaire, and BMI was calculated from measured height and weight.Results: No differences in mean energy, macronutrient, or micronutrient intakes were observed between mothers and fathers within either area of residence.Dyad-level analyses showed that in rural households, mothers had higher caloric (p = 0.001), vitamin A (p = 0.048), and zinc intakes (p = 0.001) than fathers, who had higher iron intakes (p < 0.001) than mothers.In urban households, mothers had higher caloric (p = 0.006) and zinc intakes (p < 0.001) than fathers, who had higher iron intakes (p < 0.001) than mothers.The prevalence of overweight/obesity was higher among mothers than fathers in both urban (70% vs. 40%, p = 0.020) and rural (67% vs. 30%, p = 0.005) households. J o u r n a l P r e -p r o o f Conclusion:The coexistence of overweight/obesity and low iron intakes among mothers highlights a unique presentation of the DBM at the household level.The AIM-2 shows promise for addressing limitations of traditional dietary assessment methods through passive and objective image capture.