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International Archives of Medicine logoLink to International Archives of Medicine
. 2014 Jul 11;7:34. doi: 10.1186/1755-7682-7-34

Energy and nutrient intakes among Sri Lankan adults

Ranil Jayawardena 1,2,✉, Shalika Thennakoon 2, Nuala Byrne 1, Mario Soares 3, Prasad Katulanda 1, Andrew Hills 4
PMCID: PMC4110527  PMID: 25067954

Abstract

Introduction

The epidemic of nutrition related non-communicable diseases such as type 2 diabetes mellitus and obesity has reached to epidemic portion in the Sri Lanka. However, to date, detailed data on food consumption in the Sri Lankan population is limited. The aim of this study is to identify energy and major nutrient intake among Sri Lankan adults.

Methods

A nationally-representative sample of adults was selected using a multi-stage random cluster sampling technique.

Results

Data from 463 participants (166 Males, 297 Females) were analyzed. Total energy intake was significantly higher in males (1913 ± 567 kcal/d) than females (1514 ± 458 kcal/d). However, there was no significant gender differences in the percentage of energy from carbohydrate (Male: 72.8 ± 6.4%, Female: 73.9 ± 6.7%), fat (Male: 19.9 ± 6.1%, Female: 18.5 ± 5.7%) and proteins (Male: 10.6 ± 2.1%, Female: 10.9 ± 5.6%).

Conclusion

The present study provides the first national estimates of energy and nutrient intake of the Sri Lankan adult population.

Keywords: Dietary survey, Nutrition survey, Energy intake, Sri Lanka, Adults

Introduction

The epidemic of nutrition related non-communicable diseases (NCDs) such as type 2 diabetes mellitus, obesity, Cardio Vascular Diseases (CVDs) and certain cancers are continuing to challenge the health sectors in Asia [1]. Sri Lanka is a low-middle income South Asian country with a population of 20 million. Despite Sri Lanka’s relatively good health status, during the last two decades NCDs have become a more prominent health issue in the country [2]. A quarter of Sri Lankan adults suffer from metabolic syndrome [3]. According to Sri Lanka Diabetes and Cardiovascular Study (SLDCS), the prevalence of diabetes among Sri Lankan adults was nearly 11% and one fifth of adults in Sri Lanka have diabetes or pre-diabetes while one third of those with diabetes are undiagnosed [4]. Premarathna et al., have also reported that there was an increase in the incidences of hospitalization of Sri Lankan adults by 36%, 40% and 29% due to diabetes mellitus, hypertensive disease and ischemic heart disease, respectively, in 2010 compared to 2005 [5]. In Sri Lanka, diet-related chronic diseases currently account for 18.3% of all deaths and 16.7% of hospital expenditure [1]. There is a significant health burden due to NCDs and this will be a challenge to the health sector in a developing country like Sri Lanka.

Some methods to assess the quantity and quality of dietary intake include prospective food records (with weighed or estimated food portions), retrospective 24-hour recalls (24 HDR), and food frequency questionnaires (FFQs) [6]. The 24HDR which is less time consuming and has a low respondent burden, is the method used to gather the quantitative estimate of all foods and beverages that an individual has consumed in the previous 24 hours at a population level. Several national dietary surveys have used 24 HDR and it is known to be acceptable for gathering dietary information on a given day at the population level [7,8].

National diet and nutrition surveys provide valuable information on a possible partial explanation for the eople’s health status and disease risk [9]. Assessment of the dietary and nutritional status of the population is essential to monitor the ongoing nutrition transition in a country [6]. As a developing country, no studies have been carried out to investigate the information on the diet of Sri Lankans and their nutritional status at a national level. Since Sri Lanka is a multi cultural country, peoples’ foods and dietary habits at a national level should be assessed with a representative sample of Sri Lankan adults, which will be more useful to implement health policies and to initiate many interventions. By keeping this view in mind, the current dietary survey was carried out to assess the intakes of energy, macro-nutrients and selected other nutrients with respect to socio demographic characteristics and the nutritional status of Sri Lankan adults.

Methodology

Study sampling and the subjects

The eligible respondents of this study were healthy Sri Lankan adults aged ≥ 18 years recruited from a sub sample of a Sri Lanka Diabetes and Cardiovascular Study [4]. In this study, a total of 600 subjects were randomly selected representing all nine provinces. This sample population was then stratified for area of residence and ethnicity. Description of sample selection is published elsewhere [10]. Written informed consent for participation in the study was obtained and ethical approval for this study was taken from the Ethical Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka.

Measurements

Socio-demographic variables

The selected subjects were initially contacted via telephone or a postal notice by the study team and the information regarding the study was provided in order to obtain their willingness to participate in the study. On the study day, the purpose of the study was briefly explained to the subjects and the information sheets of the study were also given out. Written consent was obtained from each volunteer prior to data collection. Socio-demographic details and diabetes status were obtained by using an interviewer-administered questionnaire and body weight and height were measured using a standard method. Areas of residence, ethnicities, and education levels were categorized according to Sri Lankan governmental standards [11]. Body mass index (BMI) was calculated by weight (in kilograms) divided by height squared (in meters) and several cut-offs were presented as recommended by WHO experts for Asian populations [12].

Dietary assessment

Dietary data were obtained from a 24 HDR method. The subjects were asked to recall all foods and beverages, consumed over the previous 24-hour period. Respondents were probed for the types of foods and food preparation methods. For uncommon mixed meals, the details of recipes and preparation methods were collected at the time of taking the 24 HDR. Dietary recalls were collected by two trained nutritionists who had received uniform training and adhered to the standard operating procedure (SOP). As dietary assessment aids, the standard household measurements such as plate, bowl, cup, glass, and different spoons etc. and food photograph atlases were used to facilitate the quantification of portion sizes. One medium sized coconut spoon of rice was taken as 100 g, a full plate as 400 g, one cup of liquid as 150 ml, one glass of liquid as 200 ml, a table spoon as 15 g and a tea spoon was taken as 5 g. For different curries, weights of average respective amounts were taken. Household measurements were clarified by demonstration of the real utensils and the food portion size photographs. When subjects recalled some food amount in grams, that information was directly entered. Further details of dietary assessment were published previously [10].

Data analysis

All foods recorded in 24 HDR were converted into grams and then, the intake of total energy, macro nutrients (Carbohydrate, Protein and Fat), sodium and dietary fiber were analyzed using NutriSurvey 2007 (EBISpro, Germany) which was modified for Sri Lankan food recipes. As no updated nutritional database has been gathered for some Sri Lankan food, we used the US Department of Agriculture (USDA) nutrient database [13] as our standard to estimate nutrient content in addition to local and regional food composition databases [14,15]. Due to the absence of energy and nutrient information on local mixed cooked dishes, we used a cookery book [16]. All the recipes were accepted after checking for face validity by consulting local housewives and nutritionists. According to recipes, ingredients were weighed to the nearest 1 g for edible portions of the foods. Then food items were cooked accordingly and the end product was weighed. Nutritional composition of the final meal was calculated by entering nutritional values and the weights of individual ingredients to the spreadsheet. The sum of each nutrient was computed and standardized to 100 g of final product. We also excluded participants whose reported daily energy intake was not between 800 and 4200 kcal to identify under- and over-reporters of food intake [17].

Statistical analysis

All data were doubly entered and rechecked in Microsoft Excel 2007. Data sorting and cleaning were carried out before data analysis. Data on energy, macro-nutrients and some selected nutrient intakes were transferred from the NutriSurvey 2007 to the Minitab version 15.0 for statistical analysis. Nutrient intake distributions are presented as mean ± SE, median, 25th and 75th percentiles to characterize population intake levels for socio-demographic characteristics (gender, ethnicity, age groups, and educational levels) and BMI categories. One-way ANOVA and t-test were used to examine the differences in mean intakes energy and nutrients intakes. P value < 0.05 was considered statistically significant.

Results

Socio-demographic profile

From 600 subjects, 491 (81.8%) participated and 28 of subjects under-reported their energy intake. So, a total of 463 (77.2%) was included for the analysis. Socio demographic profiles and BMI categories of the subjects are presented in Table  1. The majority of the subjects were from rural areas (59.7%) and 33% of the population were from urban areas followed by the estate sector (tea plantation area) 7.3%. The majority were women (n = 297). By ethnic groups, Sinhalese (78%), Sri Lankan Tamil (9%), Indian Tamil (7%), and Muslim (6%) in this survey. Adults between the age of 41 and 50 years formed the biggest group (25.27%) while the smallest group was the youngest adults aged between 18-30 yrs (13.17%). It was significant that a majority of the study population (39%) had received formal education up to Ordinary Level. The next largest group was adults (25%) who had studied up to Advanced Level.

Table 1.

Socio-demographic characteristics of the survey population

Characteristics Total (n = 463)
 Men (n = 166)
 Women (n = 297)
n % n % n %
Area of residence
  
  
  
  
  
  
  Urban
 153
 33.0
 45
 26.5
 108
 36.4
  Rural
 276
 59.6
 102
 61.4
 174
 58.6
  Estate
 34
 7.4
 19
 11.5
 15
 5.0
Age group (yrs)
  
  
  
  
  
  
  18-29
 61
 13.2
 27
 16.3
 34
 12.7
  30-39
 84
 18.1
 23
 13.8
 61
 22.8
  40-49
 117
 25.3
 38
 22.9
 79
 29.6
  50-59
 106
 22. 9
 40
 20.1
 66
 24.7
  >60
 95
 20.5
 38
 22.9
 57
 21.4
Ethnicity
  
  
  
  
  
  
  Sinhala
 360
 77.7
 118
 71.0
 242
 82.5
  Muslim
 27
 5.8
 8
 4.8
 19
 6.4
  Sri Lankan Tamil
 42
 9.1
 20
 12.1
 22
 7.4
  Indian Tamil
 34
 7.3
 20
 12.1
 14
 4.7
Educational level
  
  
  
  
  
  
  No schooling
 27
 58.3
 11
 6.6
 16
 5.4
  Up to 5 years
 113
 24.4
 43
 25.9
 70
 23.6
  Up to O/L
 182
 39.3
 59
 35.5
 123
 41.4
  Up to A/L
 116
 25.1
 46
 27.7
 70
 23.6
  Graduate
 25
 5.4
 07
 4.2
 18
 6.1
BMI category
  
  
  
  
  
  
  ≤ 18.5 kg.m-2
 64
 13.8
 29
 17.5
 35
 11.8
  > 18.5 - ≤ 22.9 kg.m-2
 163
 35.2
 75
 45.2
 88
 29.6
  > 23 - ≤ 24.99 kg.m-2
 76
 16.4
 21
 12.6
 55
 18.5
  > 25 - ≤ 27.5 kg.m-2
 95
 20.5
 32
 19.3
 63
 21.1
  ≥ 27.5 kg.m-2 65 14.1 09 5.4 56 18.9
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Energy intake

Table  2 represents the distribution of energy intake of Sri Lankan adults. The mean energy intake of men was significantly higher (1912.7 kcal/d) than that of women (1513.6 kcal/d) (p < 0.05). People living in the estate sector have a significant lower energy intake compared to both the urban and rural subjects (p < 0.05). Muslims had the highest intake of daily energy (1748.8 kcal) while Indian Tamils had the lowest (1437.7 Kcal/d) which statistically significant for both men and women (p < 0.05). Energy consumption of both gender groups declined gradually with their age. Energy intake increased gradually with educational level. According to BMI categories, lower energy levels were reported in both extremes and no distinct pattern was seen.

Table 2.

Energy intake (kcal) of Sri Lankan adults by socio-demographic characteristics

Characteristics All subjects (n =463)
 Men (n = 166)
 Women (n = 297)
Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
      25 75       25 75       25 75
Area of residence
  Urban
 1669
 45
 1594
 1217
 2005
 1910
 89
 1899
 1522
 2218
 1569
 50
 1453
 1158
 1885
  Rural
 1677
 32
 1590
 1304
 1994
 1975
 57
 1926
 1518
 2300
 1502
 32
 1462
 1193
 1728
  Estate
 1439
 61
 1468
 1114
 1690
 1581
 72
 1635
 1294
 1847
 1258
 87
 1340
 973
 1470
Ethnicity
  Sinhala
 1669
 28
 1256
 1589
 1977
 1947
 51
 1901
 1518
 2247
 1533
 30
 1447
 1173
 1790
  Muslim
 1749
 84
 1435
 1647
 2156
 1949
 173
 1984
 1458
 2324
 1664
 91
 1626
 1401
 2026
  Sri Lankan Tamil
 1671
 100
 1189
 1526
 2091
 2061
 161
 2094
 1660
 2352
 1317
 62
 1334
 1071
 1523
  Indian Tamil
 1438
 61
 1468
 1114
 1690
 1546
 77
 1634
 1225
 1833
 1283
 90
 1354
 993
 1472
Age group (years)
  18-30
 1832
 75
 1942
 1297
 2301
 2166
 95
 2064
 1942
 2392
 1567
 91
 1385
 1108
 2052
  31-40
 1808
 64
 1661
 1403
 2059
 2250
 148
 1777
 1633
 2726
 1641
 56
 1596
 1346
 1892
  41-50
 1634
 46
 1545
 1268
 1906
 1810
 89
 1848
 1418
 2099
 1549
 51
 1507
 1197
 1821
  51-60
 1614
 49
 1544
 1233
 1905
 1859
 70
 1639
 1595
 2037
 1465
 60
 1361
 1134
 1701
  >61
 1487
 47
 1394
 1138
 1747
 1688
 84
 2155
 1305
 2094
 1353
 48
 1257
 1068
 1626
Educational level
  No schooling
 1287
 73
 1202
 905
 1589
 1442
 115
 1484
 1123
 1792
 1181
 89
 1117
 882
 1469
  Up to 5 years
 1556
 39
 1528
 1233
 1831
 1748
 69
 1715
 1380
 1992
 1438
 42
 1451
 1138
 1655
  Up to O/L
 1677
 40
 1788
 1299
 2468
 1970
 77
 1873
 1493
 2356
 1536
 41
 1473
 1194
 1787
  Up to A/L
 1823
 55
 1763
 1378
 2183
 2058
 89
 2086
 1590
 2292
 1668
 65
 1583
 1224
 2008
  Graduate
 1594
 102
 1470
 1226
 2000
 2221
 119
 2234
 1977
 2543
 1350
 78
 1265
 1065
 1635
BMI category
  ≤ 18.5 kgm-2
 1548
 64
 1409
 1173
 1799
 1782
 113
 1637
 1288
 2151
 1354
 54
 1325
 1135
 1466
  >18.5 - ≤ 22.9 kgm2
 1731
 45
 1642
 1296
 2064
 1946
 66
 1886
 1522
 2290
 1548
 56
 1439
 1113
 1907
  >23 - ≤ 24.9 kgm-2
 1666
 60
 1570
 1294
 1857
 1910
 118
 1817
 1493
 2083
 1532
 62
 1466
 1233
 1724
  > 25 - ≤ 27.5 kgm-2
 1674
 52
 1677
 1285
 1977
 1988
 99
 1987
 1650
 2324
 1556
 56
 1579
 1224
 1790
  ≥ 27.5 kgm-2 1541 54 1520 1169 1871 1851 147 1892 1569 2103 1491 56 1430 1138 1728
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Carbohydrate intake

The mean daily carbohydrate intake was shown in Table  3. The total mean carbohydrate intake of Sri Lankan adults was approximately 304.4 g (71.2% of total energy from Carbohydrates as shown in Figure  1). By strata, rural adults had a higher intake of carbohydrate (307.7 g) than their estate counterparts (270.3 g). Mean carbohydrate intake was highest in Sinhalese (308.7 g) and lowest in Indian Tamils (269.9 g). Male adults’ carbohydrate intake (352.4 g/day) was significantly higher than that of women (277.5 g/day). Carbohydrate intake declined with age.

Table 3.

Carbohydrate intake (g) of Sri Lankan adults by socio-demographic characteristics

Characteristics All subjects (n =463)
 Men (n = 166)
 Women (n = 297)
Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
      25 75       25 75       25 75
Area of residence
  Urban
 305.9
 8.7
 290.7
 217.5
 373.5
 343.5
 16.3
 346.7
 262.8
 414.1
 290.4
 10.0
 259.1
 259.1
 349.1
  Rural
 307.7
 6.2
 292.3
 233.0
 365.7
 367.1
 11.4
 353.9
 285.3
 425.6
 272.8
 5.88
 262.1
 262.1
 324.7
  Estate
 270.3
 11.8
 266.6
 213.0
 320.6
 295.0
 13.7
 309.5
 237.2
 345.4
 239.0
 17.7
 237.2
 237.2
 262.7
Ethnicity
  Sinhala
 308.7
 5.6
 292.3
 229.7
 368.0
 363.1
 10.3
 346.8
 289.3
 427.7
 282.2
 5.9
 262.0
 214.3
 330.8
  Muslim
 298.0
 13.9
 299.9
 245.2
 348.4
 316.8
 30.7
 282.8
 247.3
 404.6
 290.0
 15.1
 299.9
 245.2
 348.4
  Sri Lankan Tamil
 298.9
 17.7
 269.9
 203.4
 375.1
 367.9
 27.3
 369.6
 315.9
 402.0
 236.1
 12.6
 226.8
 199.6
 267.2
  Indian Tamil
 269.9
 11.9
 266.6
 213.0
 320.6
 288.0
 14.7
 300.6
 233.8
 341.5
 244.2
 18.1
 237.7
 196.2
 270.8
Age group (years)
  18-30
 338.9
 15.1
 340.2
 233.7
 425.8
 401.9
 19.0
 400.7
 345.5
 440.1
 289.0
 18.6
 247.7
 206.0
 392.2
  31-40
 305.0
 10.8
 299.5
 252.8
 344.1
 423.6
 28.6
 395.8
 309.5
 477.8
 305.0
 10.8
 299.5
 252.8
 344.1
  41-50
 298.7
 8.6
 294.6
 232.8
 352.1
 330.4
 17.1
 316.3
 252.4
 381.3
 283.4
 9.4
 272.6
 226.9
 333.3
  51-60
 291.9
 9.4
 273.5
 225.5
 348.5
 339.1
 13.2
 329.0
 275.1
 398.1
 263.2
 11.4
 235.4
 198.2
 321.7
  >61
 273.8
 9.1
 261.0
 203.9
 324.8
 310.2
 16.4
 306.6
 233.7
 371.9
 249.5
 9.35
 239.0
 201.4
 390.4
Educational level
  No schooling
 242.9
 13.5
 235.7
 174.2
 305.5
 270.9
 21.1
 259.2
 211.4
 318.2
 223.6
 16.4
 216.2
 160.6
 258.0
  Up to 5 years
 286.4
 7.8
 276.4
 228.9
 331.6
 323.8
 14.3
 317.6
 244.5
 386.8
 263.5
 7.9
 261.3
 216.1
 307.1
  Up to O/L
 309.3
 7.7
 290.8
 233.2
 364.8
 366.8
 15.5
 345.5
 290.9
 415.5
 281.8
 7.4
 262.6
 221.1
 329.5
  Up to A/L
 332.5
 11.1
 323.1
 243.7
 399.0
 373.1
 16.9
 374.7
 300.3
 427.9
 305.9
 13.8
 279.6
 216.0
 360.8
  Graduate
 284.8
 18.5
 239.0
 203.6
 343.1
 399.2
 22.5
 401.6
 323.0
 440.4
 240.3
 13.5
 232.2
 200.0
 293.1
BMI category
  ≤ 18.5 kgm-2
 292.0
 13.3
 254.2
 220.1
 329.8
 342.6
 23.5
 323.7
 237.5
 401.9
 250.1
 10.3
 238.2
 205.7
 268.8
  >18.5 - ≤ 22.9 kgm2
 318.1
 8.7
 301.6
 230.5
 376.3
 356.3
 12.5
 335.8
 291.5
 418.3
 285.5
 11.0
 258.5
 213.2
 349.5
  >23 - ≤ 24.9 kgm-2
 305.2
 12.1
 275.1
 236.2
 349.9
 350.5
 22.6
 346.7
 266.6
 401.7
 280.2
 12.8
 258.5
 213.2
 349.5
  > 25 - ≤ 27.5 kgm-2
 303.4
 9.8
 301.9
 236.3
 356.3
 363.2
 20.3
 368.0
 291.3
 426.0
 280.9
 9.8
 283.1
 214.9
 331.7
  ≥ 27.5 kgm-2 282.4 10.4 264.6 221.4 334.1 325.8 28.2 317.6 263.4 378.0 275.5 11.0 262.8 211.1 329.4
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Figure 1.

Figure 1

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Percentage energy contribution from macronutrients according to gender, ethnicity and area of residance, BMI, educational level and age group.

Protein intake

Sri Lankan adults recorded a mean daily protein intake of 44.6 g whilst men’s intake (52.8 g) was significantly higher than women’s intake (40.0 g). As shown in Table  4, rural (42.9 g/day) and estate (43.7 g/day) adults had similar daily intakes of protein. However, by ethnicity, mean protein intake was significantly higher in Muslims (52.2 g) compared others. Youngest group by age also consumed significantly more protein than others but only for men.

Table 4.

Protien intake (g) of Sri Lankan adults by socio-demographic characteristics

Characteristics All subjects (n =463)
 Men (n = 166)
 Women (n = 297)
Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
      25 75       25 75       25 75
Area of residence
  Urban
 47.8
 3.6
 41.0
 31.8
 53.3
 62.7
 11.6
 47.7
 37.8
 67.1
 41.6
 1.4
 38.8
 29.7
 50.5
  Rural
 42.9
 0.9
 39.8
 32.5
 50.7
 48.7
 1.6
 45.6
 35.6
 57.9
 39.5
 1.0
 37.6
 29.9
 46.2
  Estate
 43.7
 2.4
 42.1
 32.6
 54.9
 50.4
 3.1
 53.0
 38.8
 61.9
 35.1
 2.2
 33.8
 27.3
 44.4
Ethnicity
  Sinhala
 44.2
 1.6
 39.8
 32.1
 50.5
 52.6
 4.5
 35.6
 35.6
 57.1
 40.1
 0.9
 37.5
 29.7
 47.6
  Muslim
 52.2
 2.6
 49.9
 40.9
 61.3
 58.6
 5.1
 47.3
 47.3
 70.1
 49.4
 2.9
 47.7
 40.2
 60.8
  Sri Lankan Tamil
 44.1
 3.2
 38.8
 29.8
 52.8
 54.8
 5.5
 38.6
 38.6
 65.1
 34.4
 1.8
 34.0
 27.9
 39.6
  Indian Tamil
 43.4
 2.5
 42.1
 32.6
 54.9
 48.9
 3.3
 38.2
 38.2
 61.0
 35.3
 2.5
 33.9
 27.3
 44.4
Age group (yrs)
  18-30
 57.4
 8.6
 46.8
 34.3
 60.6
 74.9
 18.8
 52.3
 43.8
 74.9
 43.4
 2.6
 41.0
 31.8
 53.9
  31-40
 47.6
 2.0
 42.9
 34.5
 52.6
 59.5
 4.8
 53.3
 41.5
 72.5
 43.1
 2.0
 40.4
 32.6
 47.0
  41-50
 42.6
 1.2
 41.0
 32.7
 50.5
 46.5
 2.3
 44.9
 35.5
 54.3
 40.8
 1.4
 49.9
 37.9
 69.8
  51-60
 41.9
 1.5
 38.1
 29.6
 50.8
 48.4
 2.5
 48.2
 37.0
 56.2
 38.0
 1.7
 34.6
 27.3
 46.2
  >61
 39.1
 1.4
 34.4
 29.9
 45.4
 43.7
 2.5
 40.2
 32.2
 54.9
 36.0
 1.6
 33.5
 28.6
 41.0
Educational level
  No schooling
 33.1
 2.0
 33.8
 25.3
 38.3
 67.7
 22.1
 52.3
 43.8
 74.9
 31.9
 2.7
 32.4
 24.2
 41.1
  Up to 5 years
 41.9
 1.4
 38.8
 30.5
 49.3
 59.5
 4.8
 53.3
 41.5
 72.5
 38.8
 1.5
 37.7
 28.6
 44.7
  Up to O/L
 42.7
 1.1
 39.6
 32.4
 50.5
 46.5
 2.3
 44.9
 35.5
 54.3
 39.4
 1.1
 36.4
 30.0
 46.3
  Up to A/L
 52.9
 4.7
 45.5
 35.7
 56.5
 48.4
 2.5
 48.2
 37.0
 56.3
 44.4
 1.8
 40.8
 32.7
 53.8
  Graduate
 44.24
 3.5
 40.2
 32.2
 57.5
 43.7
 2.5
 40.2
 32.2
 54.9
 39.4
 4.1
 34.3
 29.5
 41.9
BMI Category
  ≤ 18.5 kgm-2
 41.6
 1.2
 39.9
 31.8
 46.6
 45.8
 2.9
 43.0
 35.6
 52.4
 38.1
 2.3
 34.1
 29.6
 43.2
  >18.5 - ≤ 22.9 kgm2
 47.6
 3.4
 41.0
 32.5
 53.3
 55.6
 7.0
 46.0
 36.2
 59.1
 40.6
 1.6
 37.8
 29.4
 50.3
  >23 - ≤ 24.9 kgm-2
 44.6
 2.0
 41.1
 32.7
 49.3
 52.8
 3.9
 47.7
 35.6
 59.0
 40.0
 1.8
 34.1
 29.6
 43.2
  > 25 - ≤ 27.5 kgm-2
 43.8
 1.5
 39.9
 32.6
 54.4
 52.6
 2.8
 53.2
 41.9
 64.4
 40.5
 1.7
 37.9
 30.5
 48.7
  ≥ 27.5 kgm-2 41.1 1.7 37.7 29.5 48.3 52.1 6.2 56.3 33.3 70.8 39.3 1.7 36.5 29.0 46.3
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Fat intake

Estimated daily mean fat intake of Sri Lankan adults was 35 g. A more or less similar fat consumption was noted for rural and urban residents (Table  5) whereas estate people had significantly lower intake of fat (24.76 g; p < 0.05). The youngest age group recorded the highest fat intake (37.7 g) while the lowest intake was observed in the oldest age group (30.8 g). By ethnic groups, Muslims had the highest fat intake (44.7 g) whilst the Indian Tamils had the lowest (24 g) which is significantly lower than Muslims (p < 0.05). With education level, fat consumption was increased particularly among men. Adults with normal BMI and BMI > 25 - ≤ 27.5 kgm-2 had a higher fat intake than other BMI categories.

Table 5.

Fat intake (g) of Sri Lankan adults by socio-demographic characteristics

Characteristics All subjects (n =463)
 Men (n = 166)
 Women (n = 297)
Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
      25 75       25 75       25 75
Area of residence
  Urban
 35.3
 1.3
 31.3
 23.8
 43.2
 42.8
 2.98
 37.1
 27.6
 58.2
 32.2
 1.3
 29.8
 22.8
 38.5
  Rural
 36.1
 0.9
 34.2
 23.8
 43.8
 41.9
 1.70
 39.1
 29.6
 50.2
 32.7
 1.1
 30.2
 21.6
 40.6
  Estate
 24.8
 1.8
 22.3
 17.0
 34.8
 27.3
 2.39
 22.8
 17.9
 35.4
 21.6
 2.6
 18.7
 14.6
 26.4
Ethnicity
  Sinhala
 34.8
 0.8
 32.4
 23.0
 42.6
 40.4
 1.53
 37.6
 28.7
 49.8
 32.1
 0.9
 29.8
 21.5
 39.6
  Muslim
 44.7
 4.0
 37.9
 29.4
 61.3
 57.0
 8.68
 55.4
 37.5
 78.6
 39.6
 3.8
 36.4
 25.0
 54.6
  Sri Lankan Tamil
 39.0
 2.9
 32.8
 25.6
 52.0
 48.2
 4.67
 46.0
 30.2
 62.9
 30.6
 2.4
 28.6
 22.1
 35.4
  Indian Tamil
 24.9
 1.8
 22.3
 17.2
 34.8
 26.8
 2.32
 22.3
 17.4
 35.3
 22.2
 2.7
 21.2
 15.7
 26.9
Age group (years)
  18-30
 37.7
 2.2
 36.3
 24.8
 44.9
 45.0
 3.58
 39.1
 33.8
 60.4
 32.0
 2.2
 30.8
 22.6
 41.7
  31-40
 36.6
 1.8
 33.9
 24.6
 44.3
 45.4
 4.48
 40.1
 29.5
 60.9
 33.2
 1.7
 29.6
 24.2
 42.2
  41-50
 35.4
 1.6
 31.8
 24.1
 41.9
 40.5
 2.96
 37.7
 28.0
 53.2
 33.0
 1.8
 30.8
 21.6
 39.0
  51-60
 35.6
 1.6
 32.8
 22.7
 45.0
 38.8
 2.82
 34.3
 24.0
 49.7
 33.6
 1.8
 32.4
 22.1
 39.2
  >61
 30.8
 1.4
 27.4
 20.7
 39.6
 36.1
 2.39
 34.2
 23.7
 46.8
 27.3
 1.7
 24.4
 19.0
 33.0
Educational level
  No schooling
 23.6
 2.1
 20.5
 16.4
 30.8
 26.6
 3.34
 22.8
 17.9
 32.8
 21.4
 2.6
 19.5
 13.6
 29.0
  Up to 5 years
 32.1
 1.2
 39.2
 23.2
 29.9
 34.9
 1.84
 35.4
 24.9
 42.0
 30.4
 1.5
 29.0
 22.3
 36.6
  Up to O/L
 35.0
 1.2
 31.7
 22.1
 44.8
 40.3
 2.30
 38.0
 25.3
 52.2
 32.5
 1.3
 29.0
 20.7
 41.0
  Up to A/L
 39.6
 1.6
 36.4
 26.7
 46.0
 46.0
 3.05
 39.4
 31.9
 60.8
 35.4
 1.7
 34.6
 24.3
 42.8
  Graduate
 39.3
 3.9
 34.2
 23.8
 58.5
 61.6
 5.25
 60.9
 56.6
 76.1
 30.6
 3.2
 35.4
 21.8
 28.4
BMI category
  ≤ 18.5 kgm-2
 28.8
 1.8
 24.2
 17.3
 35.6
 33.3
 3.04
 28.0
 19.6
 43.8
 25.1
 2.0
 22.6
 16.4
 30.6
  >18.5 - ≤ 22.9 kgm2
 37.2
 1.4
 34.8
 23.7
 46.7
 42.6
 2.16
 38.8
 29.2
 51.8
 32.3
 1.5
 30.0
 22.1
 40.9
  >23 - ≤ 24.9 kgm-2
 34.2
 1.6
 32.5
 25.4
 39.5
 39.0
 3.52
 33.7
 26.9
 57.5
 32.0
 1.5
 32.6
 25.6
 38.0
  > 25 - ≤ 27.5 kgm-2
 36.8
 1.6
 35.8
 24.1
 45.5
 42.2
 3.06
 38.3
 29.6
 53.3
 34.8
 1.9
 32.8
 22.2
 44.8
  ≥ 27.5 kgm-2 34.0 2.0 28.7 24.0 40.0 44.9 7.02 37.8 26.4 66.2 32.3 2.0 28.6 22.4 39.3
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Energy contribution from macro nutrients

As a whole, 71.2% energy come from carbohydrates among Sri Lankan adults, 10.8% from protein and 18.9% from fat. Comparisons of the percentage of energy derived from macronutrients according to socio demographic profile and BMI categories were shown in Figure  1. By ethnic distribution, Muslims had more energy from fat (22.3%) while Indian Tamils had the lowest amount of fat (15.5%) and highest intake of carbohydrates (75%). The percentage of calories from protein were relatively higher among the graduates. In contrast, adults who did not receive a formal education had a higher percentage of energy from carbohydrates compared to other groups. There was no difference in energy distribution between diabetic and non-diabetic subjects.

Dietary fiber

The daily mean dietary fiber intake of Sri Lankan adults was 18.1 g (men: 21.3 g; women: 16.3 g; p < 0.05). By area of residence, estate adults had a higher dietary fiber intake (20.6 g) than their urban and rural counterparts (Table  6). Mean dietary fiber intake was highest in Indian Tamils (20.6 g) and lowest in Sinhalese (17.6 g) (p < 0.05). Dietary fiber intake increased with educational level and a similar trend was observed for women as men. Daily dietary fiber intake was always higher among men than women with different socio demographic characteristics. Adults aged > 60 years had the lowest intake of fiber.

Table 6.

Dietary fiber intake (g) of Sri Lankan adults by socio demographic characteristics

Characteristics All subjects (n =463)
 Men (n = 166)
 Women (n = 297)
Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
      25 75       25 75       25 75
Area of residence
  Urban
 18.1
 0.7
 16.2
 12.2
 22.6
 19.7
 1.4
 17.0
 13.8
 25.5
 17.5
 0.8
 15.4
 11.9
 21.0
  Rural
 17.7
 0.5
 16.6
 12.2
 21.3
 21.3
 0.8
 18.6
 15.6
 26.8
 15.6
 0.5
 15.1
 11.1
 19.0
  Estate
 20.6
 1.9
 17.7
 12.8
 28.7
 24.9
 2.8
 22.3
 14.6
 33.1
 15.2
 1.5
 16.7
 8.8
 19.5
Ethnicity
  Sinhala
 17.7
 0.4
 16.4
 12.1
 21.4
 20.2
 0.8
 17.8
 14.1
 24.9
 16.4
 0.5
 15.6
 11.3
 19.7
  Muslim
 18.8
 1.4
 18.0
 12.8
 24.4
 22.4
 2.3
 22.7
 16.7
 24.8
 17.2
 1.7
 15.3
 12.1
 19.5
  Sri Lankan Tamil
 18.8
 1.3
 17.4
 12.4
 26.4
 23.8
 2.0
 26.4
 15.6
 31.8
 14.3
 1.0
 13.6
 11.1
 18.6
  Indian Tamil
 20.6
 1.9
 17.6
 12.8
 28.7
 24.5
 2.6
 20.8
 15.2
 32.7
 15.0
 1.6
 15.5
 8.7
 19.9
Age group (years)
  18-30
 18.1
 1.0
 16.9
 11.7
 22.3
 21.6
 1.7
 21.0
 14.2
 26.5
 15.3
 1.1
 14.4
 10.7
 19.2
  31-40
 18.6
 0.9
 17.1
 13.0
 22.1
 22.8
 1.8
 20.9
 17.0
 27.1
 17.0
 0.9
 16.4
 12.2
 20.0
  41-50
 18.2
 0.7
 17.0
 13.4
 22.0
 19.9
 1.5
 17.4
 14.0
 25.5
 17.4
 0.8
 16.4
 12.9
 20.5
  51-60
 18.8
 0.9
 16.5
 12.0
 25.4
 23.4
 1.6
 20.4
 15.6
 31.3
 16.0
 1.0
 14.4
 10.1
 19.6
  >61
 16.6
 0.8
 15.6
 10.5
 20.4
 19.3
 1.4
 18.3
 14.8
 23.7
 14.8
 1.0
 13.0
 9.2
 18.8
Educational level
  No Schooling
 15.6
 1.2
 19.1
 10.5
 17.0
 17.0
 2.2
 17.2
 10.5
 22.1
 14.6
 1.4
 15.9
 10.1
 18.9
  Up to 5 years
 17.6
 0.8
 15.4
 11.8
 20.4
 21.9
 1.7
 18.3
 14.1
 29.1
 15.0
 0.8
 13.6
 10.8
 18.8
  Up to O/L
 17.6
 0.6
 16.3
 12.2
 21.0
 20.5
 1.1
 17.4
 14.1
 26.8
 16.2
 0.6
 15.6
 11.4
 19.6
  Up to A/L
 19.9
 0.8
 18.4
 13.9
 25.3
 22.3
 1.3
 21.0
 15.8
 26.9
 18.2
 1.1
 17.7
 12.8
 22.1
  Graduate
 17.8
 1.6
 18.0
 10.6
 23.0
 24.2
 2.7
 23.3
 22.4
 27.1
 15.3
 1.7
 13.6
 9.8
 20.1
BMI category
  ≤ 18.5 kgm-2
 16.9
 0.9
 15.8
 11.9
 21.2
 18.8
 1.4
 17.2
 13.8
 23.4
 15.4
 1.0
 14.3
 10.6
 19.4
  >18.5 - ≤ 22.9 kgm-2
 19.1
 0.7
 17.1
 13.0
 22.6
 23.0
 1.1
 20.9
 15.6
 27.4
 15.8
 0.8
 14.6
 11.5
 18.8
  >23 - ≤ 24.9 kgm-2
 17.3
 1.0
 16.2
 11.2
 22.0
 19.1
 1.8
 16.7
 13.2
 26.8
 16.4
 1.1
 13.8
 10.8
 20.8
  > 25 - ≤ 27.5 kgm-2
 18.2
 0.7
 17.0
 13.6
 22.4
 20.6
 1.4
 17.2
 15.8
 26.6
 17.4
 0.8
 16.4
 13.1
 20.9
  ≥ 27.5 kgm-2 17.2 1.2 15.5 9.3 20.4 23.6 4.4 21.2 11.9 33.2 17.3 0.8 16.4 13.0 20.6
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Sodium

Daily mean sodium intake was 3.26 g and 2.51 g for men and women, respectively (p < 0.05). Dietary sodium intake of Sri Lankan adults according to demographic and BMI categories is shown in Table  7. Mean sodium intake of rural adults was 2.89 g, followed by urban adults (2.73 g). The Estate sector had the lowest intake (2.48 g). Muslims and Sri Lankan Tamils had a higher intake of sodium than Sinhalese and Indian Tamils. With aging, sodium intake declined and the youngest age group recorded the highest intake (3.04 g).

Table 7.

Sodium intake (mg) of Sri Lankan adults by socio-demographic characteristics

Characteristics All subjects (n =463)
 Men (n = 166)
 Women (n = 297)
Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
 Mean
 ±SE
 Median
 Percentiles
      25 75       25 75       25 75
Area of residence
  Urban
 2729
 102
 2509
 1835
 3411
 3100
 196
 3003
 1952
 3893
 2574
 116
 2362
 1711
 3242
  Rural
 2890
 81
 2582
 2025
 3507
 3396
 155
 3190
 2448
 4211
 2605
 84
 2374
 1870
 3143
  Estate
 2477
 156
 2378
 1800
 3072
 2889
 184
 2665
 2377
 3502
 1954
 200
 2036
 1359
 2350
Ethnicity
  Sinhala
 2769
 61
 2523
 1934
 3391
 3155
 107
 2969
 2228
 3877
 2580
 70
 2372
 1825
 3225
  Muslim
 3012
 301
 2610
 1941
 3910
 2983
 345
 3256
 2085
 3760
 3023
 407
 2469
 1612
 4023
  Sri Lankan Tamil
 3306
 333
 2797
 1954
 4487
 4400
 588
 4492
 2624
 5463
 2311
 176
 2189
 1803
 2859
  Indian Tamil
 2488
 154
 2378
 1800
 3072
 2831
 184
 2598
 2144
 3467
 1997
 209
 2096
 1440
 2363
Age group (years)
  18-30
 3045
 145
 3071
 2186
 3519
 3436
 238
 3179
 2536
 4258
 2736
 162
 2873
 1915
 3441
  31-40
 2940
 144
 2532
 2048
 3667
 3883
 311
 3856
 2379
 4669
 2584
 135
 2390
 1903
 2985
  41-50
 2778
 99
 2536
 2048
 3667
 2976
 173
 2655
 2163
 3833
 2683
 120
 2480
 2023
 3245
  51-60
 2832
 162
 2448
 1817
 3441
 3188
 307
 2560
 2013
 3924
 2616
 180
 2211
 1678.
 3299
  >61
 2564
 114
 2363
 1652
 3265
 3108
 187
 3106
 2290
 3822
 2201
 123
 2003
 1577
 2511
Educational level
  No schooling
 2290
 193
 2157
 1359
 2954
 2923
 279
 2530
 2200
 3562
 1855
 206
 1740
 1203
 2302
  Up to 5 years
 2697
 114
 2403
 1847
 3351
 2984
 169
 2772
 2198
 3813
 2521
 148
 2188
 1684
 3032
  Up to O/L
 2825
 104
 2500
 1944
 3461
 3353
 233
 3200
 2057
 3910
 2571
 99
 2371
 1903
 3031
  Up to A/L
 2971
 113
 2715
 2122
 3437
 3300
 187
 2999
 2479
 4385
 2755
 136
 2645
 1937
 3249
  Graduate
 3046
 269
 3126
 1739
 3910
 4384
 447
 4432
 3562
 5215
 2526
 241
 2663
 1506
 3408
BMI category
  ≤ 18.5 kgm-2
 2580
 147
 2296
 1649
 3383
 3124
 252
 2927
 2052
 4219
 2129
 129
 2054
 1541
 2793
  >18.5 - ≤ 22.9 kgm2
 3029
 114
 2665
 2069
 3622
 3464
 192
 3231
 2509
 4111
 2659
 121
 2449
 1879
 3261
  >23 - ≤ 24.9 kgm-2
 2775
 150
 2486
 1914
 3241
 2896
 232
 2536
 1958
 3716
 2708
 196
 2443
 1858
 3211
  > 25 - ≤ 27.5 kgm-2
 2756
 120
 2509
 1974
 3405
 3179
 119
 3213
 2278
 4126
 2596
 143
 2257
 1800
 3240
  ≥ 27.5 kgm-2 2615 133 2351 1769 3502 3286 435 3810 2099 4306 2507 135 2255 1660 3287
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Discussion

Although national dietary and nutrition surveys have a number of important functions and can provide much valuable information, Sri Lanka had never conducted a national food consumption survey before, probably due to lack of human and financial resources. This is the first attempt to report energy and macronutrients intakes in a fairly representative sample over the island using updated food composition data. Subject distribution of ethnic groups, area of residence and educational levels closely mirror the national statistics [11].

Differences in calorie consumption were seen according to demographic and BMI categories. Men consume larger portions of foods and are expected to obtain a higher amount of energy than their female counterparts [18]. The intake of energy by Sri Lankan men was found to be higher than that of women by about 350 kcals. Similar differences were reported among Malaysian adults [19] and in Britain the difference was nearly 700 kcal [20]. When compared to people living in urban and rural areas, estate workers are getting the least energy. Lower mean energy intake was reported among Malaysian estate workers [21]. The decline in calorie consumption with age was probably due to reduction in physical activity levels and poor appetite, particularly in older adults. Different energy intakes in ethnic groups may represent their cultural eating habits. For instance, Muslim people tend to have a higher energy intake and eat more fat rich food items compared to Indian Tamils. Up to A/L by education level, energy consumption was gradually increased, this is probably associated with increased purchasing power with higher education status; however, graduate groups may be also aware of health issues associated with excess energy. In developed countries, calorie consumption is inversely associated with education levels [22]. Except for the very obese category, consumption of total energy intake was steadily rising with BMI categories. Under-reporting of food intake by obese subjects is well documented [23].

The total daily intake of protein in Sri Lankan adults is almost half that of the US adults and, among Americans 2/3 of all protein, is derived from animal sources [24]. In contrast, plant sources (rice and pulses) are the main contributors of protein among Sri Lankan adults [10,25]. American men consume over 100 gms of fat daily and for women it is 65 g [26]. Corresponding values for Sri Lankans are 40.5 grams and 31.9 grams. In addition to the amount of fat, the type of fat is crucial for development of diet-related chronic diseases such as cardiovascular disease. Although, sub types of fat are not reported in this analysis, the main lipid source in Sri Lankan diet is coconut milk/oil which is high in saturated fatty acids [27]. Therefore, it is important to conduct further studies to explore the coconut consumption and associated cardiovascular disease risk in this population.

Energy-providing macronutrient proportions could vary in different populations. According to the ranges of population nutrient intake goals recommended by WHO, the percentage of energy from total carbohydrates, fats and proteins should be 55-75%, 15-30% and 10-15%, respectively [28]. British adults consume less than fifty percent of energy (men: 47.7%; women: 48.5%) from carbohydrates, whilst fat intake contributes 35.8% and 34.9% of total energy for men and women respectively. The contribution of protein as an energy source is 16.5% for both sexes [20]. In contrast to western countries, Malaysians get nearly 60% of their energy from carbohydrates, 14% of energy from protein and the rest from fats [19]. In contrast to western countries and some Asian countries, Sri Lankan adults consume proportionally more carbohydrates (>71% of energy) and less fat (<19% of energy) and proteins (<11%). The prevalence of diabetes in Sri Lanka is 11% and one fifth of adults are suffering from diabetes despite low levels of obesity (BMI > 30 = 3.7%). Since the study is cross-sectional in nature, we cannot conclude the association between the relatively larger contribution of energy from carbohydrate and higher prevalence of diabetes/dysglycemia among Sri Lankan adults, in spite of carbohydrates contributing over 70% of energy for both diabetics and non-diabetics. Longitudinal studies assessing the prospective risk of developing diabetes and the proportion of energy derived from macronutrients are needed to fully elucidate an association. A high intake of carbohydrate may lead to hyperinsulinaemia, high serum TAG and low HDL-cholesterol levels and chronic consumption of large carbohydrate meals may cause postprandial hyperglycaemia and hypertriacylglycerolaemia and eventually develop insulin resistance and diabetes [29].

A generous intake of dietary fiber reduces risk of developing many diseases including coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal disorders as well as improving metabolic parameters and immune functions [30]. The definition, method of measuring fiber and recommendations varies in different countries. The backbone of our food composition data is based on USDA. According to US guidelines, the current recommendation is to consume 14 g per every 1000 kcals, therefore using the energy guideline of 2000 kcal/day for women and 2600 kcal/day for men, the recommended daily dietary fiber intake is 28 g/day for adult women and 36 g/day for adult men [31]. Although Sri Lankan adults consume fewer energy compared to US adults, their dietary fiber intake is insufficient according to their calorie intake.

Epidemiological, clinical and animal-experimental evidence showed a direct relationship between dietary electrolyte consumption and blood pressure [32]. Furthermore, clinical trials show that a reduction in salt (NaCl) intake reduces BP levels in normotensive and hypertensive populations and prevents the development of hypertension [32]. Recommended Na intake is maximum of 2.3 g/day [32]. Our findings showed most Sri Lankan adults exceed current recommendations. The high consumption of Sodium may be associated with the epidemic of hypertension (Men: 18.8%; Women: 19.3%) among Sri Lankan adults [33].

This study has several limitations. Sri Lanka has over 20 million inhabitants. Therefore, diet records of a sample of 463 subjects may not represent the eating patterns of the whole population. However, a well-conducted UK NDNS [20] measured the dietary records of 1724 respondents and achieved a lower response rate of 47%. Considering available resources, the high response rate and satisfactory representation of demographic parameters, we believe this is a reasonable sample size. Secondly, 24HDR may not be the best tool to determine habitual diet, because of the non-representative diet and recall bias. However, we selected random 24HDR, which were evenly distributed within weekdays and weekends. Random 24HDR in a large sample has been used in other national surveys in other countries [7]. Thirdly, our findings were limited to energy and selected major macronutrients due to sub quality nutritional information on sub categories of macronutrients and micronutrients of Sri Lankan mixed dishes (Additional file 1). Another limitation is that despite of reports of high alcohol consumption among Sri Lankan men [34], alcohol intake was under-reported in our study (<0.5%). In this survey, low energy reporters (<800 kcal/day) were excluded, therefore exclusion will have biased the data towards higher intakes. Lastly, we did not attempt to correlate energy intake and its adequacy to this population as calorie recommendations may vary with several factors such as gender, age, body weight, body composition and physical activity level.

Acknowledging the limitations of the survey, the present study provides the first national estimates of energy and nutrient intake of the Sri Lanka adult population. It is evident that consumption of high levels of carbohydrate, fat mainly from saturated sources, low protein, low dietary fiber and high levels of sodium may have detrimental effects on health and be related to the current epidemic of NCDs. Unfortunately, current food-based dietary guidelines are based on limited research [25]. Therefore, well-designed and nationally representative studies are needed to explore the association between diet and chronic disease among Sri Lankan adults. Moreover, regular diet and nutrition surveys should be carried out to obtain information on dietary patterns and nutrient intakes and, ideally, periodical monitoring is needed to identify the changing trends in food intake and to assess public responses to dietary recommendations.

Competing interests

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors declare that they have no financial or non-financial competing interests.

Authors’ contributions

RJ contributed to the data collection, data analysis and drafted the manuscript. ST analyzed nutrient values. NB, MS, PK and AH were supervisory team members on the project and contributed to study design, interpretation of data and revision of the manuscript. All authors read and approved the final manuscript.

Supplementary Material

Additional file 1

Selected micronutrient intake among Sri Lankan adults.

Click here for file (14.1KB, docx)

Contributor Information

Ranil Jayawardena, Email: ranil7@gmail.com.

Shalika Thennakoon, Email: shalika_san@yahoo.com.

Nuala Byrne, Email: n.byrne@qut.edu.au.

Mario Soares, Email: M.Soares@curtin.edu.au.

Prasad Katulanda, Email: pkatulanda@yahoo.com.

Andrew Hills, Email: ahills@mmri.mater.org.au.

Acknowledgements

The authors would like to acknowledge Miss Fathima Shakira and other members in the Diabetes Research Unit, Colombo, for their contribution in arranging logistics for the study.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Additional file 1

Selected micronutrient intake among Sri Lankan adults.

Click here for file (14.1KB, docx)

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