Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

Abstract

Objective: To assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children. Methods: Secondary data analyses were undertaken with nationally representative data of 1-8-year-old children (n ¼ 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated. Results: The children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal ¼ 100%) was 50%, and was lowest (45%) in the 7-8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the 'other group' (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r ¼ 0.726; P , 0.0001) and DDS (r ¼ 0.657; P , 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity. Conclusion: Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

Association of a summary index of child feeding with diet quality and growth of 6–23 months children in urban Madagascar

“…This result adds to the growing evidence in developing countries showing that higher dietary diversity is associated with better child growth (Onyango et al, 1998;Hatloy et al, 2000;Arimond and Ruel, 2004;Steyn et al, 2006) and thus confirms its potential usefulness as an indicator of the quality of complementary feeding.…”

Association of Dietary Variety and Diversity With Body Mass Index in US Preschool Children

“…Furthermore, previous literature shows that greater dietary variety and diversity are associated with a decreased risk for nutritional inadequacy. [36][37][38][39] The inconsistent findings in the literature of dietary variety or diversity may be due, in part, to different serving cutoff points to determine if the consumption of a particular food will count toward the variety or diversity score. For example, in the study by Mirmiran et al, 10 at least half a serving of a food must be consumed for it to count toward the diversity score; in the Diet Diversity 10-g score created by…”

Is the school food environment conducive to healthy eating in poorly resourced South African schools?

“…The diet has little variety (6,7) and is deficient in many of the key micronutrients (5) . Vitamin A-rich vegetables and fruit are the most neglected foods (6) .…”