LAUSR

Objectives This study describes dietary patterns of women in Nepal and how dietary patterns vary by under-and-overweight, socioeconomic status (SES), and agro-ecological zone. Methods In 2016, a national mid-year nutrition and health survey was conducted in Nepal. In each zone (mountains, hills and Tarai) 7 sub-districts (village development communities, VDCs) were systematically selected after a random start (N = 21). Within each VDC, 3/9 wards (N = 63) were sampled in proportion to population and all households were enumerated. In all, 5380 women, married <2 years or having >1 child <72 mo of age, were assessed for weight, height, caste, SES, & food security among other factors. Diet was assessed by a 7-day food frequency questionnaire with 48 items. Latent class analysis was used to generate dietary patterns, consolidated into 12 food groups. Goodness-of-fit indicators supported a 7 class (dietary pattern) model. Chi2 tests were used to test statistically significant differences in dietary patterns by characteristics. Results National median [IQR] intake frequencies for key foods by women were: fruits 3 [1,7], vegetables 12 [7,20], meat 1 [0.3], eggs 0 [0,1], and dairy 6 [ 0,14]. Only 10% of women consumed fruits or vegetables 5 times per week. Dietary patterns (% of women) identified included: 1) Most diverse (18%); 2) Diverse no egg no alcohol (17%); 3) Diverse orange fruit, veg and milk (4%); 4) Moderate (13%); 5) Non-diverse meat and alcohol (10%); 6) Low moderate diversity with oil and fat (22%); and 7) Monotonous (17%). Patterns 2 and 6 were distinct of the Tarai and pattern 3 more evident in the Hills. Significant variation was evident by wealth quintile, food security status, caste, zone, and body mass index (BMI). Women whose intakes aligned with Pattern 1 had the highest prevalence of BMI >25.0 kg/m2 (26.7%) and those eating pattern 3, the lowest (1.4%). Pattern 1 had the lowest prevalence of BMI <18.5 kg/m2 (12.6%), and pattern 6 the highest (28.8%). Conclusions Dietary patterns of women in Nepal are heterogeneous, vary by SES, agro-ecological and cultural factors, and are associated with risk of over and underweight. Funding Sources Supported by USAID through the Feed the Future Nutrition Innovation Lab, with additional assistance from Sight and Life and the Bill & Melinda Gates Foundation.