Dietary diversity scores, nutrient intakes and biomarkers vitamin B₁₂, folate and Hb in rural youth from the Pune Maternal Nutrition Study

Abstract

Hidden hunger is widespread in India. Individual dietary diversity score (IDDS) is a measure of the nutrient adequacy of the diet. The Food and Agricultural Organisation (FAO) has set guidelines for measurement of dietary diversity: the IDDS and the minimum dietary diversity score for women (MDD-W) to assess nutritional deficiency but validation against nutritional biomarkers is required. Using available data among rural youth (17 years) from the Pune Maternal Nutrition Study (PMNS) the validity of DDS was assessed to measure deficiencies of vitamin B12, folate and haemoglobin. Of the 355 boys and 305 girls 19% were classified as underweight, 57% as B12 deficient (<150pmol/L) and 22% as anaemic (<12/13g/dL). Cereals, legumes and ‘other-vegetables’ were the most frequently consumed foods. More boys than girls consumed milk, flesh, eggs, and micronutrient-dense foods. Median IDDS 4(3,4 IQR) and MDD-W 6(5,7) were low. Youth with B12 deficiency had a higher likelihood of an IDDS≤4 (1.89 95%CI 1.24,2.87) or a MDD-W≤5 (1.40 95%CI 1.02, 1.94). Youth with anaemia were more likely to have an IDDS ≤4 (1.76 95%CI 1.01,3.14) adjusted for socio-economic scores, body mass index, calorie intake and sex. Folate deficiency was low (3%) and was not associated with either score. Youth with lowest plasma-B12 and haemoglobin infrequently or never consumed dairy/non-vegetarian foods. These rural Indian youth were underweight, had low DDS and consumed foods low in good quality proteins and micronutrients. Associations of DDS with circulating micronutrients indicate that DDS is a valid measure to predict B12 deficiency and anaemia.

Food group diversity and nutrient adequacy: Dietary diversity as a proxy for micronutrient adequacy for different age and sex groups in Mexico and China

“…The underlying 10-point score is also associated with micronutrient adequacy. The indicator was developed based on analyses of data from nine sites in six countries (five low-income and one lower-middle-income); subsequently, associations between MDD-W (and/or its underlying score) and nutrient intakes and adequacy have been demonstrated in a number of studies from diverse contexts (7)(8)(9)(10)(11)(12)(13)(14).…”

“…its latest survey round; 2 measurement of MDD-W was also piloted by the Gallup World Poll in several countries as part of a broader diet quality module. 3 Though developed for women of reproductive age (WRA), MDD-W or its underlying score have sometimes been used to describe diversity for other age/sex groups (9), reflecting strong demand for metrics for other groups, as well as for WRA. Given its origins and use to date, there is limited information on associations with nutrient adequacy in upper-middleincome countries, although one recent multi-country study in Latin America demonstrated positive associations (10).…”

“…Consumption of at least 15 grams is required for a food group to 'count' in the score. The 10 food groups are: (1) Grains, white roots and tubers, and plantains, (2) Pulses (beans, peas, and lentils), (3) Nuts and seeds, (4) Dairy, (5) Meat, poultry, and fish, (6) Eggs, (7) Dark green leafy vegetables, (8) Other vitamin A-rich fruits and vegetables, (9) Other vegetables, and (10) Other fruits.…”

“…An upper confidence limit of the BMR factor for single-day intakes and high physical activity would have been preferable but was not provided by Black, 2000 (19). 9 Information on self-reported dieting is available for China only, for children 6-17 years only.…”

“…9. Differences in estimation of prevalence of consumption of food groups, when 1-gram or 15-gram minima are…”