Eating architecture components and their associations with BMI in urban and rural Ghanaian mothers, fathers, children, and adolescents, assessed using a wearable camera: A cross-sectional study.

Abstract

Eating architecture - timing, frequency, and size of meals and snacks - affects metabolism, but data from low-middle-income countries (LMICs) are scarce. We examined eating architecture (timing, frequency, and size of eating occasions) among Ghanaian households and its relationship with BMI. Thirty rural and 30 urban Ghanaian households participated. A wearable camera on eyeglasses captured dietary intake over 2 weekdays and 1 weekend day. Custom software was used for nutritional analysis and identifying eating episodes. Meals were distinguished from snacks by time, context, and items consumed. Eating frequencies were 2.4-2.7 x/d, and eating windows were 6.5-9.5 h/d. Children ate more frequently than other household members and had longer eating windows than fathers. Eating and energy intake peaked at 8:00 h and 12:00 h, respectively. Only 56% of urban and 72% of rural members snacked. Meal energy was similar across locations, but snack energy was higher among urban versus rural households, positively associated with BMI among urban mothers. Ghanaian eating architecture varied by location, household member, and differed from high-income countries. Only the size component of eating architecture, namely snack energy, was associated with BMI, and only in urban mothers. Our findings highlight the need to address nutritional disparities in Ghana and other LMICs.