Examining macro and micronutrient intakes in the Sri Lankan twin cohort: validation of subjective biomarkers from the COTASS-3 study

This study is part of the Colombo Twin and Singleton Study – 3 (COTASS-3), conducted by the Institute for Research and Development in Health and Social Care, Sri Lanka, in Collaboration with Kings College London.

For a healthy life, eating a balanced diet is crucial as it reduces the risk of many diseases. The aim of the study was to understand the diets of adults living in the Colombo District and evaluate whether it meets their nutritional needs and to check whether a simple dietary questionnaire can accurately measure what people eat. Unhealthy eating habits and lack of essential nutrients are major health concerns in Sri Lanka. The country faces a “double burden” of malnutrition, where some people experience undernutrition while others are affected by overweight and obesity. At the same time Nutrition related diseases such as diabetes and heart disease are increasing. This study was conducted between 2020 -2023 during a period where Sri Lanka faced a severe economic crisis that affected food availability and affordability across the country. These challenges may have influenced people usual dietary patterns, along with having a reliable and cost-effective tool to assess them, is important for informing future public health policies and interventions.

The objectives of this study were:

• To describe macro and micronutrient intakes in the Colombo district of Sri Lanka during the economic crisis. 

• To explore the association between socio-demographic factors and different nutrient intake. 

• To compare dietary data with blood and urine-based biomarkers.

The study aimed to determine whether nutrient intake reported through dietary questionnaires reflects participants ‘actual nutritional status by comparing with biological markers measured from blood and urine samples. It also explored differences in dietary adequacy across age groups and the possible impact of economic challenges on food choices. By combining dietary assessments with laboratory analysis, the study evaluated the reliability of questionnaires for measuring dietary intake in the Sri Lankan population. The findings may help improve dietary recommendations and support better nutritional assessment practices in Sri Lanka.