title: Consuming cassava as a staple food places children 2-5 years old at risk for inadequate protein intake, an observational study in Kenya and Nigeria.
abstract: BACKGROUND
  Inadequate protein intake is known to be deleterious in animals. Using WHO consensus documents for human nutrient requirements, the protein:energy ratio (P:E) of an adequate diet is > 5%. Cassava has a very low protein content. This study tested the hypothesis that Nigerian and Kenyan children consuming cassava as their staple food are at greater risk for inadequate dietary protein intake than those children who consume less cassava.
  
  
  METHODS
  A 24 hour dietary recall was used to determine the food and nutrient intake of 656 Nigerian and 449 Kenyan children aged 2-5 years residing in areas where cassava is a staple food. Anthropometric measurements were conducted. Diets were scored for diversity using a 12 point score. Pearson's Correlation Coefficients were calculated to relate the fraction of dietary energy obtained from cassava with protein intake, P:E, and dietary diversity.
  
  
  RESULTS
  The fraction of dietary energy obtained from cassava was > 25% in 35% of Nigerian children and 89% of Kenyan children. The mean dietary diversity score was 4.0 in Nigerian children and 4.5 in Kenyan children, although the mean number of different foods consumed on the survey day in Nigeria was greater than Kenya, 7.0 compared to 4.6. 13% of Nigerian and 53% of Kenyan children surveyed had inadequate protein intake. The fraction of dietary energy derived from cassava was negatively correlated with protein intake, P:E, and dietary diversity. Height-for age z score was directly associated with protein intake and negatively associated with cassava consumption using regression modeling that controlled for energy and zinc intake.
  
  
  CONCLUSIONS
  Inadequate protein intake was found in the diets of Nigerian and Kenyan children consuming cassava as a staple food. Inadequate dietary protein intake is associated with stunting in this population. Interventions to increase protein intake in this vulnerable population should be the focus of future work.
authors.affiliation: Department of Pediatrics, St Louis Children's Hospital, St Louis, MO, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Stephenson
authors.forename: Rachel
authors.initials: R
authors.lastname: Amthor
authors.forename: Sally
authors.initials: S
authors.lastname: Mallowa
authors.forename: Rhoda
authors.initials: R
authors.lastname: Nungo
authors.forename: Busie
authors.initials: B
authors.lastname: Maziya-Dixon
authors.forename: Simon
authors.initials: S
authors.lastname: Gichuki
authors.forename: Ada
authors.initials: A
authors.lastname: Mbanaso
authors.forename: Mark
authors.initials: M
authors.lastname: Manary
mesh_terms: D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet / Q000379:methods*; D005247:Feeding Behavior; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D002365:Manihot; D009549:Nigeria / Q000453:epidemiology; D009753:Nutritive Value; D011488:Protein Deficiency / Q000453:epidemiology*; D012307:Risk Factors