Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) Data Collection: Validity of the List-Based and Open Recall Methods as Compared to Weighed Food Record

Abstract

<jats:p>Minimum dietary diversity for women of reproductive age (MDD-W) was validated as a population-level proxy of micronutrient adequacy, with indicator data collection proposed as either list-based or open recall. No study has assessed the validity of these two non-quantitative proxy methods against weighed food records (WFR). We assessed the measurement agreement of list-based and open recall methods as compared to WFR (i.e., reference method of individual quantitative dietary assessment) for achieving MDD-W and an ordinal food group diversity score. Applying a non-inferiority design, data were collected from non-pregnant women of reproductive age in Cambodia (n = 430), Ethiopia (n = 431), and Zambia (n = 476). For the pooled sample (n = 1337), proportions achieving MDD-W from both proxy methods were compared to WFR proportion by McNemar’s chi-square tests, Cohen’s kappa, and receiver operating characteristic (ROC) analysis. Ordinal food group diversity (0–10) was compared by Wilcoxon matched-pairs signed-rank tests, intraclass correlation coefficients (ICC), and weighted kappa. MDD-W food groups that were most frequently misreported (i.e., type I and II errors) by the proxy methods were determined. Our findings indicate statistically significant differences in proportions achieving MDD-W, ordinal food group diversity scores, and ROC curves between both proxy methods and WFR (p &lt; 0.001). List-based and open recall methods overreported women achieving MDD-W by 16 and 10 percentage points, respectively, as compared to WFR (proportion achieving MDD-W: 30%). ICC values between list-based or open recall and WFR were 0.50 and 0.55, respectively. Simple and weighted kappa values both indicated moderate agreement between list-based or open recall against WFR. Food groups most likely to be misreported using proxy methods were beans and peas, dark green leafy vegetables, vitamin A-rich fruit and vegetables, and other fruits. Our study provides statistical evidence for overreporting of both list-based and open recall methods for assessing prevalence of MDD-W or ordinal food group diversity score in women of reproductive age in low- and middle-income countries. Operationalizing MDD-W through qualitative recall methods should consider potential trade-offs between accuracy and simplicity.</jats:p>

Food insecurity, low dietary diversity and poor mental health among Syrian refugee mothers living in vulnerable areas of Greater Beirut, Lebanon

“…Yet, it remained much higher compared to women asylum seekers in Norway, a high-income country (49%) (69) . Hanley-Cook et al showed evidence of overreporting of food groups by 10% to 16% for assessing the prevalence of Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) using the list-based or open recall methods (74) . This suggests that the prevalence of LDD can be even higher in our study.…”

Adherence to healthy and sustainable diets is not differentiated by cost, but rather source of foods among young adults in Albania

“…The first limitation of our observational analysis is the single 24HR, obtained from a relatively small sample of young adults in Tirana. Although 24HRs provide a higher degree of accuracy for assessing food and nutrient intake relative to food frequency questionnaires, such dietary assessment methods are prone to measurement error due to respondent memory lapses and social desirability/approval of specific food and drinks (62) . Moreover, 24HRs are appropriate to estimate population average dietary intakes, but do not account for intra-person variability (63) and thus estimation of usual dietary intake (64) .…”

The global challenge of hidden hunger: perspectives from the field

“…The indicator is dichotomous, with the threshold for achieving minimum dietary diversity set at a score of ≥5. A comparison of the recall and a list-based method against a weighed food intake record revealed that both methods are likely to over-report the number of women achieving the minimum score (29) . In a study of dietary diversity in a resource poor setting in Pakistan, we reported that MMD-W was not achieved by most of the participants.…”