Simple Food Group Diversity Indicators Predict Micronutrient Adequacy of Women’s Diets in 5 Diverse, Resource-Poor Settings

Abstract

Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.

Determining minimum food intake amounts for diet diversity scores to maximize associations with nutrient adequacy: an analysis of schoolchildren’s diets in rural Kenya

“…Our eight-food-group system shared a number of similarities to the recently recommended nine-food-group system also known as the Women's Dietary Diversity Score (WDDS) and the seven-group young children's (6 to 23 months old) DDS (12,23,24) . All three systems have specific food groups for cereals and tubers, dairy products and legumes and nuts.…”

“…It is however important to note that our system differed from the WDDS in three specific ways: (i) we categorized VAFV and VCFV into two separate food groups; (ii) we did not categorize organ meats and flesh foods into two separate food groups; and (iii) we combined the MFP and egg categories into one food group due to the low intake values. Although Arimond et al showed that the nine-food-group system combined better performance and ease of implementation (12) , we selected to use eight food groups in our analysis to allow for 'food group' key nutrient homogeneity and practicality within our specific population.…”

“…Unlike the developed nations, only a few studies in less-developed nations have imposed a minimum food group intake amount when defining food group 'consumers' (1,(8)(9)(10)(11)(12) . An assessment of some of these studies shows that imposing a standard 10 g or 15 g minimum intake produces a DDS that not only has a stronger association with nutrient intake but also shows a greater resilience to energy adjustment and has a better ability to differentiate children or women with different intake levels of nutrient adequacy (10)(11)(12)(13) . While the use of a fixed minimum amount across all food groups is easy to apply, such a set minimum may not consider varying contributions of food groups to nutritional needs.…”

Agricultural research for nutrition outcomes – rethinking the agenda

“…The two most frequently used individual indicators of dietary diversity, Minimum Dietary Diversity (MDD) for children 6-23 months of age and Women's Dietary Diversity, have been validated as proxy indicators of the nutrient adequacy of the diet (Arimond et al 2010;FAO and IRD 2014;WHO 2008). Many studies have shown positive associations between dietary diversity scores and nutritional outcomes (Ruel et al 2013b) and dietary diversity indicators are collected by large scale programs such as the Demographic and Health Surveys, Feed the Future, and CGIAR.…”

Dietary contribution of Wild Edible Plants to women’s diets in the buffer zone around the Lama forest, Benin – an underutilized potential

“…In resource-poor settings worldwide, low-quality, monotonous diets are common and the risk of micronutrient deficiencies is high (Arimond et al 2010;FAO 2013b). At the same time, global supply of food energy is dependent on only a small number of cultivated species and varieties (Barucha and Pretty 2010;FAO 2013a;Grivetti and Ogle 2000).…”