(P19-006-24) Nutrient Intake and Diet Quality Impacts of a Nutrition-Sensitive Resilience Program in Sri Lanka

Objectives: R5N was an agriculture-based resilience program to strengthen rural farming communities against shocks and to improve livelihoods. It was conducted by the World Food Programme (WFP) and Government of Sri Lanka from 2019 to 2022, with or without an 8-mo health promotion process (HPP).  We aimed to assess the impacts of R5N and R5N+HPP on diet quality and nutrient intakes among adults in the program area.

Methods: R5N used a diversified livelihoods approach. WFP selected 30 villages for R5N based on assessed need, and half of these were randomly selected to also receive HPP. A control group of 15 villages was selected by village-level matching.

Respondents completed 1-2 phone-based 24-hr dietary recalls at baseline and 12-mo follow-up. Food group and nutrient intakes were estimated using Sri Lankan dietary reference tables. Diet quality was assessed using the Global Diet Quality Score (GDQS).

Difference-in-difference (DID) comparisons of All R5N vs. Control and R5N+HPP vs R5N Only were tested. Effects on GDQS were tested using regression models with propensity score weights and k-nearest neighbor matching. Effects on usual nutrient intakes and were analyzed using the National Cancer Institute method with propensity score weighting and Welch’s t-test with bootstrapped standard errors.

Results: The DID (95%CI) in GDQS for All R5N vs. Control and R5N+HPP vs. R5N Only were -0.26 (-0.79, 0.27) and 1.51 (0.79, 2.24), respectively.  Positive DID effects on intakes of fiber, B vitamins, vitamin C and vitamin A were found for All R5N relative to control.  No significant negative DID effects on intakes were found. Nutrient intake comparisons of R5N Only vs. R5N+HPP were non-significant.

Conclusions: The R5N program had multiple significant impacts on diet, including a mix of beneficial, protective and null effects on nutrient intakes. Contrasting results for All R5N vs. Control and R5N+HPP vs. R5N Only on GDQS may indicate a beneficial effect of HPP on healthy food choices. Further programs to increase consumption of nutrient-rich foods are warranted in rural Sri Lanka.

Funding Sources: We would like to thank all funders who support this research through their contributions to the CGIAR Trust Fund: www.cgiar.org/funders. The R5N program evaluation was also supported by WFP, A4NH and the USDA. The Korea International Cooperation Agency funded the R5N Program.