Background: The photographic food atlas, a portion size measurement aid has been used to estimate, quantify, educate and counsel on appropriate food portions to help improve dietary intake, and achieve a healthy change. Consumption of larger portion sizes is associated with increases in non-communicable diseases (NCDs), however; most people do not know what makes up a portion. NCDs are on the increase in Ghana. A photographic food atlas with portions sizes of commonly consumed foods in Ghana is needed to help educate and improve on portion sizes in order to control the increase risk of NCDs in Ghana.
Aim: The aim of this study was to identify commonly consumed carbohydrate based foods in Accra, Ghana, and to produce and validate a photographic food atlas with portion sizes based on gender, age and BMI.
Method: A three phased cross-sectional study was employed. This consisted of identifying, collating and categorizing commonly consumed and most commonly consumed carbohydrate foods (phase 1), developing a photographic food atlas based on data collected (phase 2) and estimating randomly selected cooked portions of most commonly consumed carbohydrate foods from the developed photographic food atlas in a pilot and a major part (phase 3). The study involved eight hundred and eight (808) participants in the first phase, fifty (50) males and females of equal distribution in the pilot and two hundred and eighty (280) participants in the major phase. The study took place in three hundred and eighty four (384) conveniently selected households from thirty (30) randomly selected suburbs in the five (5) metropolitan areas of the four (4) income zones in the Greater Accra Region. Socio-demographic information, carbohydrate consumption, recipe collation for the first phase of the study were obtained through pretested questionnaires, three day food diaries, recipe booklets, a recipe book and on-line recipes. The commonly consumed carbohydrate foods identified were cooked in portions of between one (1) and eight (8), weighed, plated, coded, coloured photographed, cropped, captured on A-4 sheets and ring bound into a photo album. The most commonly consumed foods identified from the commonly consumed carbohydrate foods were captured in photo series.
Results: Ninety one (91) common carbohydrate foods made up of 70.3% grain and cereal group, 24.2% roots, tubers and plantain group and 5.5% of beverage and sugar group were collated. The developed photographic food atlas contained twenty four (24) foods in single portions, four (4) in portions of two (2) and sixty two (62) foods in portions of eight (8). Six thousand seven hundred and twenty (6720) estimations were made. Overall, a significantly higher proportion of participants (54.17%; (P=0.03) were able to make correct estimation of portion sizes using the food atlas. On the whole gender (P=0.001) and age (P=0.018) were positively linked to estimations with a higher proportion of females (54.48%) and participants within 55-64 age range (58.13%) better at estimation. The ability of males to correctly estimate portion sizes was affected by age (P=0.024). Being of a body mass indexes (BMI) of >30 kg/m2 was statistically linked to overestimation (P=0.027). However as a group, BMI had no statistical significance on portion size estimation.
Conclusion: Generally, participants were able to estimate portion sizes correctly. Estimation was significantly affected by age and gender. However, females were better able to estimate portion sizes than males. The results from this study suggest that the developed photographic food atlas can be used to assess portions of commonly consumed carbohydrate foods in Ghana.