Discussion
anaemia
ANAEMIA
In this randomised controlled trial, we found that adult women in rural Puno, Peru, assigned to use an LPG stove, continuous fuel distribution and behavioural messaging did not have differences in daily energy, macronutrient or Na intake over 1 year when compared to controls.Contrary to our findings, Anderman This study showed that the transition from biomass to LPG stoves did not affect the dietary and Na intake in participants with similar socio-economic status. For example, we did not find that adoption of LPG resulted in increased Na consumption, which suggests that participants did not add salt to food cooked with LPG, for example, to make it taste better. We also did not find that transitioning to LPG increased total energy consumption, suggesting that participants did not prepare more food, given, for example, the increased ease or speed of food preparation. All intervention participants received a cooking demonstration before their LPG stove was installed, which may have helped them learn how to prepare traditional dishes in the same way that they did with their biomass stove. These findings suggest that the adoption of LPG by poor, rural, previous biomass users did not negatively or positively affect dietary habits.Furthermore, our study contributes information about the dietary and Na intake of women in high-altitude and rural settings of Peru which is not well-characterised in the literature. The prevalence of anaemia in children under 5 years of age in Puno is the highest in PeruOur study has some strengths. The randomised nature of our trial ensured that intervention and control participants had similar characteristics, thus allowing us to compare diet between primary LPG users and primary biomass users without potential biases from confounders. By providing free LPG fuel for 1 year, we were able to assess dietary impacts of the LPG stove over time without the common challenge that LPG users are typically wealthier than non-users. We also observed high compliance with LPG stove use among our intervention participantsThere are also some potential shortcomings. First, dietary intake was self-reported in 24-h recall surveys. Our participants, who had a high average BMI, may have underreported their dietary intake, a problem that is commonly seen in participants with high BMIOur research focussed on dietary intake among participants who were not paying for cooking fuel (LPG users received free fuel from the trial, and biomass users collected free biomass fuel). Further research is needed on dietary patterns when people must pay for their own LPG to understand how LPG purchases may affect the household’s ability to purchase food items and subsequently their dietary intake. Future studies should consider the potential impact of nutritional differences between cleaner fuels and biomass users when evaluating the impact of cleaner fuel interventions on cardiovascular and pulmonary health outcomes.Our intervention with LPG stoves did not affect dietary and Na intake within a cleaner cooking intervention trial. Our findings suggest that the promotion of LPG stoves should not be limited by concerns over potential negative dietary impacts, when implemented in a manner similar to this study. However, nutritional improvements are also unlikely to occur. Nutritional education paired with LPG stove introduction may be necessary to achieve both HAP reductions and increased adherence to nutritional guidelines to achieve maximum health benefits.