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Dietary Diversity an Indicator of Food Security or Dietary Quality? A Review of Measurement Issues and Research Needs
Abstract
Dietary diversity is usually measured using a simple count of foods or food groups over a given reference period. Our overview however revealed that studies in developed and developing countries have used a variety of food and food-group classification systems different numbers of foods and food groups and varying reference period lengths (ranging from 1 to 15 days). Research should be conducted to validate and compare indicators based on different methodological approaches. It would also be useful to continue to explore whether indicators based on food groups (a simpler approach) perform as well as those based on single foods in predicting outcomes of interest. (excerpt)
... 2. The Dietary Diversity Score (DDS), which measures the number of different foods or food groups consumed over a seven-day recall period. DDS allows flexibility in determining how many foods (groups) to include, recall period length, and the cut-offs (Hoddinott & Yohannes, 2002;Ruel, 2002). These food groups are: 1. Cereals, roots and tubers; 2. Pulses and legumes; 3. Vegetables; 4. Fruit; 5. Meat, fish and seafood, and egg; 6. Dairy products; and 7. Oils and fats. ...
... As dietary diversity indices, FCS and DDS measure caloric sufficiency, but not other dimensions of food security such as food stability or social acceptability (Coates, 2013). Furthermore, household-level measurements, via a seven-day recall period, may not reflect the accurate quality and quantity of food consumed by individuals (Ruel, 2002). ...
Food insecurity is an increasingly pressing and grave issue in contemporary Syria. The ongoing crisis has severely affected agriculture in a country which used to be food-producing and self-sufficient. This study addresses the factors that impact household-level food security in Syria. Our analysis is based on 1,381 household surveys using a structured questionnaire in 12 governorates of the country. We followed a two-stage least square regression (2SLS) approach to analyse the interconnected factors of food security. We use three different indicators to capture different dimensions of food security: the Food Consumption Score (FCS), the Dietary Diversity Score (DDS), and the Reduced Coping Strategy Index (rCSI). Our findings underscore the vital role of aid programs and post-crisis remedial assistance in bolstering farmers' resilience and enhancing their food security. Despite adverse constraints generated by the prolonged crisis, continued reliance on agricultural activities continued having a positive contribution to food security. Female-headed households experience higher food insecurity than their male-headed counterparts (MHHs). However, Female-headed households excel in nutritional diversity. Both results should be approached carefully due to data limitations. Addressing the repercussions of conflict-induced food insecurity requires mitigating the effects of the proximity of conflict zones and reducing disruptions in food value chains. Future research should consider how food security relates to gender and intra-household gender inequalities during protracted crises.
... Diet diversity is defined as the number of foods or food groups consumed over a given reference period. 26 Diet variety is considered synonymous with diet diversity. 26 Diet diversity can be measured by summing the number of foods, [27][28][29][30][31][32][33] food groups, 27,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] or foods within a food group, 49-52 e.g., number/range of vegetables eaten. ...
... 26 Diet variety is considered synonymous with diet diversity. 26 Diet diversity can be measured by summing the number of foods, [27][28][29][30][31][32][33] food groups, 27,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] or foods within a food group, 49-52 e.g., number/range of vegetables eaten. 53 Diet diversity can be measured over any period of time ranging from, e.g., one meal, one day or one year. ...
Allergic diseases are increasing both in morbidity and mortality. Genetic, environmental, and dietary factors may all be involved in this increase. Nutrition during pregnancy, breastfeeding, and early life may play a particularly important role in preventing allergic diseases. Based on current systematic reviews, the intake of specific nutrients has failed to prevent allergic disease. Prevention strategies have shifted their focus to the overall diet which can be described using diet diversity. Infant and maternal diet diversity in pregnancy has been associated with reduced allergy outcomes in childhood. Overall, diet also seems to have a marked effect on the microbiome compared to single foods. Factors that may negate the allergy-preventative effect of overall diet diversity include the addition of emulsifiers, advanced glycation end-product content, and overuse of commercial baby foods. There is a need to perform randomized controlled trials using overall dietary intake to support international food allergy guidelines. These studies should ideally be conducted by multi-professional teams.
... During times of increased food availability (May-October), 80% of children under 2 years of age met the recommended meal frequencies, but 70% did not meet nutritional requirements, eating fewer than the recommended minimum of four food groups per day (MoH, 2015). Dietary diversity (the number of different food groups consumed over a given reference period; Ruel, 2003a) is often low. A typical Timorese meal entails large quantities of purchased rice accompanied by small servings of home-grown vitamin A-rich leafy greens or vegetables (MoH, 2015). ...
... Prompts referred to food eaten at breakfast, at lunch, at dinner and for snacks. Dietary diversity was measured via the DDS, calculated from the foods reported (Arimond & Ruel, 2004;Ruel, 2003a). The DDS was composed of nine food groups: 'staple starches', 'vitamin-A rich foods', 'vegetables', 'fruit', 'legumes and nuts', 'meat, poultry and seafood', 'dairy', 'eggs' and 'sugar' (Tables 1 and S1). ...
Both child growth and dietary diversity are poor in rural Timor-Leste. The rainy season is associated with food scarcity, yet the association between seasonal scarcity, food diversity, and child growth is underdocumented. This study assesses the relationship between household dietary diversity and children's standardized growth across the 2018 food-scarce (April-May; post-rainy period) and post-harvest (October) seasons in the agricultural community of Natarbora, on the south-coastal plains of Timor-Leste. We conducted household interviews and collected anthropometric data across 98 and 93 households in the post-rainy and post-harvest periods, respectively. Consumed household foods were obtained via 24-h diet recalls and were subsequently categorized into a nine-food-group dietary diversity score (DDS; number of different food groups consumed). The DDS was related to children's standardized short-term growth (z-weight, z-body mass index [BMI] and percent change in weight over the harvest season) via linear mixed models. Across seasons, DDS increased from 3.9 (standard deviation [SD] = 1.0) to 4.3 (SD = 1.4; p < 0.05). In the post-rainy season, children in high DDS households had higher z-weight than those in low DDS households and higher z-BMI than children in medium and low DDS households. In the post-harvest period, household DDS did not predict children's z-weight but predicted z-BMI. Consumption of protein-rich foods, particularly animal-source foods and legumes, in low- and medium-DDS households may be associated with improved child growth. While consuming more animal-source foods in the post-rainy season would be ideal, promoting the consumption of locally grown legumes, such as beans and pulses, may facilitate better nutritional outcomes for more children in rural Timor-Leste.
... Poor diet, in terms of quantity and diversity, is one of the major causes of all forms of malnutrition at all stages of the life cycle. Evidence suggests that dietary diversity (DD), 'an increase in the variety of foods across and within food groups over a reference period' (9) , reflects dietary quality in terms of nutrient adequacy of a diet at an individual level (10)(11)(12)(13)(14)(15) . Food-based dietary guidelines recommend the intake of more diversified foods to address malnutrition and prevent diet-related chronic diseases (16,17) . ...
... Moreover, a study found that food insecurity status is linked with lower consumption of animal source foods, vitamin C-rich fruits and vegetables among pregnant adolescent girls (24) . It is already established that household DD reflects household food security, and a considerable association was found between individual level DD and household food security (10,13,68,69) . Besides, evidence suggests that the three pillars of food security, that is, availability, accessibility and utilisation (61,70,71) are associated with DD. ...
Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018–19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.
... A higher DDS indicates better dietary quality and diversity. DDS presents a straightforward way to measure nutrient adequacy, nutrient intake, and nutritional status [19]. We used a halfserving food image to assist the participant in recalling and answering the question. ...
... Dietary diversity is an indicator of household food security and is part of a healthy diet [19]. Our results revealed that dietary diversity is associated with perceived food security among children. ...
Few studies have investigated food security, dietary quality, or unfavorable food intake through self-reports among children and adolescents in Asia. This study assessed the association of perceived food insecurity with dietary quality and unfavorable food intake among 1111 children and 538 adolescents from economically disadvantaged families in Taiwan. Food security status was collected by a validated questionnaire. Dietary quality was examined using a dietary diversity score (DDS). Unfavorable food intake was defined as fried food, bread/cake/pastries, sugar-sweetened beverages, and biscuits/chips. Food-insecure participants had lower DDS, whole grains and protein-rich food intake than food-secure participants. Furthermore, food-insecure children had a higher frequency of unfavorable food consumption. The level of children’s food insecurity was inversely associated with DDS (β: −0.047, 95% CI: −0.085 to −0.009) but positively with bread/pastry (β: 0.103, 95% CI: 0.022–0.184) and sugar-sweetened beverages (β: 0.117, 95% CI: 0.018–0.215) intake. Adolescents who reported food insecurity and not enough money for household expenses had an odds ratio of 2.85 (95% CI: 1.15–7.10) for poor DDS relative to their food-secure and financially able counterparts. We recommended that health policy needs to include diversifying food and nutrition education for vulnerable children and adolescents to improve dietary quality.
... Our results indicate that breastfeeding for over 6 months is a risk factor for FA in offspring. This finding can be explained by dietary diversity, which is defined as the variety of foods or food combinations consumed within a specific timeframe [97]. Changes in diet significantly impact intestinal microorganisms [98]. ...
The association between breastfeeding and the occurrence of allergic rhinitis (AR) and food allergy (FA) in offspring remains inconclusive. This review aims to comprehensively explore the potential relationships between various patterns and durations of breastfeeding and allergic diseases in offspring. We systematically searched PubMed, EMBASE, Cochrane, WOS databases, and Google Scholar for observational studies published up to March 30, 2023, that investigated the link between breastfeeding and allergies in offspring. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI). Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated employing an appropriate model based on the degree of heterogeneity. A total of 68 studies, encompassing 772,142 children, were ultimately included. The findings indicated that breastfeeding for more than 6 months was associated with a reduced risk of AR (OR = 0.88, 95% CI: 0.79 to 0.98) but posed a risk for FA (OR = 1.69, 95% CI: 1.27 to 2.25). Exclusive breastfeeding exhibited a protective effect against AR (OR = 0.94, 95% CI: 0.90 to 0.97), whereas non-breastfeeding was identified as a risk factor for AR (OR = 1.48; 95% CI: 1.03 to 2.12). No significant association was observed between breastfeeding patterns and FA.
Conclusion: Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, large prospective high-quality studies are needed to investigate the potential risk of FA in children with prolonged breastfeeding. What is Known:
• The impact of breastfeeding on allergic rhinitis and food allergy in offspring is controversial.
• Previous meta-analyses fail to prove the effect of breastfeeding on food allergy in offspring of all ages.
What is New:
• Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, it potentially elevates the risk of FA in children. Non-breastfeeding is linked to an increased risk of AR in children, but there is no evidence of an association between breastfeeding patterns and FA in children.
• The impact of breastfeeding on allergic rhinitis and food allergy in offspring may vary with the time and pattern of breastfeeding.
... The number of unique food groups consumed during the previous 24 hours as described by respondents was summed up to calculate IDDS. 20 For dietary diversity, from the list of 16 food groups which include cereals, white roots and tubers, vitamin A-rich vegetables and tubers, dark green leafy vegetables, other vegetables, vitamin A-rich fruits, other fruits, organ meat, flesh-meat, eggs, fish and seafood, legumes nuts and seeds, milk and milk products, oils and fats, sweets, sugar, condiments and beverages were used as recommended by FAO. However, only nine major food groups out of the 16 were finally analyzed. ...
Background: Lack of adequate dietary diversity may contribute to the deterioration of health and nutritional status of newly diagnosed type 2 diabetes mellitus (T2DM) patients. This cross-sectional study was designed to assess the dietary diversity and related health status of 110 newly diagnosed T2DM patients. Methods: The diabetes history of the subjects was collected from the hospital's e-database. IDDS (individual dietary diversity score) was measured based on the FFQ (food frequency questionnaire) according to the FAO guidelines for measuring household and individual dietary diversity. BMI (body mass index), FBG (fasting blood glucose) level, 2h-PG (two-hour plasma glucose) level, serum creatinine level, and any signs of macro and microvascular diseases were recorded. Results: The mean±SD of IDDS was moderate, 5.74±0.85. About half of the newly diagnosed diabetic patients consumed foods with high diversity. All respondents consumed starchy foods and about half of them did not consume any green leafy vegetables. Younger patients had a lower tendency to take high IDDS diets than the older. About half of individuals were overweight or obese. Higher IDDS and lower BMI, hypertension, serum creatinine, FBG, and 2-HPG were found among males than that of the females. Approximately 35% and 20% patients had microvascular and
... Therefore, dietary pattern analysis seems more reasonable than evaluating individual nutrients or foods [57]. Dietary diversity, as one of the characteristics of a healthy diet, represents the consumption of various food items within and between food groups [58]. ...
A diet rich in proinflammatory components and inflammation are suggested to be significant risk factors for multiple sclerosis (MS). This study aimed to investigate the association between the risk of MS and the inflammatory potential of an individual’s diet and dietary diversity through pro-inflammatory/anti-inflammatory food intake score (PAIFIS) and dietary diversity score (DDS). In a hospital-based case–control study, 397 participants, including 197 patients with MS and 200 healthy participants aged over 18 years, were evaluated. The history of smoking, dietary intake, and anthropometric characteristics, including body mass index, waist circumference, total body fat, and fat-free mass were assessed. A validated 160-item semiquantitative food frequency questionnaire was used to calculate the PAIFIS and DDS scores. The mean age of the participants was 32.45 ± 8.66 years, and most were females (274, 79.4%). The PAIFIS score was significantly higher among MS patients than healthy participants (p = 0.001). Between PAIFIS and DDS, only PAFIS was significantly related to MS risk (odds ratio, 1.002; 95% confidence interval, 1.001–1.004; p = 0.001). PAIFIS, as an index of dietary inflammation, can predict MS. Further studies are needed to document these findings.
... Similarly, a study carried out on assessment of nutritional status of pre-school children from low income families in Akure (Akorede and Abiola 2013) reported poor nutritional status of majority of the subjects. The income of the household seems to be a major factor in determining the nutritional status, this is contrary to other studies (Onyango et al.,1998;Ruel, 2002). ...
This study was carried out to assess the nutritional status of preschool children under-5 years in Benue state Nigeria. in order to establish and provide baseline information on the health and nutritional status of the target group. The study was carried out using anthropometric measurements (weights and heights) which were used in determining height-forage , weight-forage and weight-for-height, these indices were compared with WHO standards. Dietary assessment was carried out using food frequency questionnaire and 24-hour dietary recall obtained from their mothers. A semi-structured pretested questionnaire was used in gathering information on the socio-demographic and economic characteristics of mothers. Data was analyzed using SPSS version 21.0. The study revealed that the younger children (3 years old) were more severely malnourished than any other age, although the nutritional status improved with increased age. There was no difference in gender. 19.1, 17.9 and 18.9% were stunted, underweight and wasted respectively. In terms of dietary diversity score, majority of the children (45.7%) had low diversity (<4 food groups), only 29.6% accessed high dietary diversity score (6-8 food groups). Cereals, roots and tuber were the most popular food group consumed by children (31.2%), eggs diversity was the least (2.6%) consumed. Majority (56.9%) of the mothers had just secondary school education, only 16.3% earned a monthly income above N25, 000. The findings show that the nutritional status of Under-5 children in the study location is poor. Malnutrition was evident among young children due to the poor socioeconomic status of their mothers.
... The strong association between household food insecurity and child growth stunting, (31,38,39) underweight, (40,41) and wasting (39) was demonstrated by other studies. This could be because food insecurity is a more proximal factor of inadequate dietary intake (42)(43)(44) and disease resulting from inadequate nutrient intake. (44) This finding implies the potential impact of household food insecurity on both chronic and acute child undernutrition. ...
To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6-23 months in SouthEast Ethiopia. A community based cross-sectional study was conducted on 580 randomly sampled mother-child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.
... Dietary diversity (DD) has been widely used in the literature as a proxy of dietary quality [31][32][33]. It is fairly straightforward, simply counting the number of foods or food groups consumed over a certain period [34][35][36]. The more food groups consumed implies higher dietary quality. ...
There is a growing literature documenting the link between parental migration and children’s health. However, few studies have explained the underlying mechanism of this observed relationship. This paper examines the effect of parental migration on children’s health through dietary diversity, using survey data collected in a less developed prefecture in South Central China in 2018. To overcome the potential endogeneity of parental migration, we instrument parental migration with the proportion of households with migrated labor force at the village level, and find that parental migration reduces children’s dietary diversity at home. Moreover, we provide suggestive evidence that the reduction in dietary diversity may attribute to significant negative separation effects whereas minimal positive income effects in migrant-sending households. This study highlights the negative effects of labor migration on the next generation’s nutrition. In those developing countries with a high prevalence of labor migration, policies that facilitate access to dietary diversity of those left-behind children are warranted.
... Lack of dietary diversity is particularly a considerable problem among poor populations of the developing world as their diets are predominantly based on starchy staples. (56,58) The dietary diversity practice might vary because of the reference difference to calculate DDS, the number of food groups included in the score, production, and lack of accessibility to diversified diet like animal source foods, fruits, and vegetables through well-established markets, seasonal variability, variations in geographical location, socioeconomic, and cultural preference differences across the countries. ...
Undernutrition in elders remains under-detected, under-treated, and under-resourced and leads to further weight loss, increased infections, and delay in recovery from illness as well as increased hospital admissions and length of stay. The reports of the findings were fragmented and inconsistent in Ethiopia. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of undernutrition and its association with dietary diversity among older persons in Ethiopia. Online databases (Medline, PubMed, Scopus, and Science Direct), Google, Google Scholar, and other grey literature were used to search articles until the date of publication. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The random effect model was used to estimate the pooled prevalence; whereas subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity using Stata version 14.0 software. Out of 522 studies accessed, 14 met our criteria and were included in the study. A total of 7218 older people (aged above 60 years old) were included in the study. The pooled proportion of undernutrition among older persons in Ethiopia was 20⋅6 % (95 % CI 17⋅3, 23⋅8). Elders who consumed low dietary diversity scores were strongly associated with undernutrition among older persons. Therefore, promoting appropriate intervention strategies for elders to improve dietary diversity practices and nutritional status is crucial.
... Dietary diversity is widely used to measure a child's nutritional adequacy in individual and household levels in many food security studies [76,77,78]. In all the agroecological zones of Ghana, the child's nutritional adequacy is low, with a mean dietary diversity score of 2.23 out of 7. Similar findings have also been reported in several child nutrition studies in Ghana [43,79]. ...
... Lo anterior señala que en la estructura energética de la canasta de alimentos de Suroeste tiene gran peso cuatro alimentos con baja densidad de nutrientes lo cual incide de manera negativa en la posibilidad de garantizar la cantidad y calidad de proteínas y de micronutrientes que requieren los integrantes del hogar. Situación que a su vez limita la variedad de la alimentación, considerada como un indicador de una dieta saludable(28).En este estudio el 13,8% de las kilocalorías disponibles en los hogares fueron aportadas por alimentos de origen animal, porcentaje menor al reportado en la Sexta Encuesta (17,4%), la mayor diferencia se encuentra en el aporte del grupo de carnes y productos cárnicos que en Suroeste fue de 4,5% y en la Encuesta de 8,4%(22). El alto consumo de alimentos de origen vegetal sugiere que a los hogares, las condiciones socioeconómicas no les permiten tener acceso a una alimentación más variada, así otras limitantes como las prácticas alimentarias dejando a un lado la calidad de la dieta.En la región del Suroeste, los grupos de alimentos con la principal contribución a las proteínas totales disponibles en el hogar fueron los de origen vegetal, el mayor aporte fue dado por el grupo de cereales (33,1%), lo cual concuerda con los datos reportados para América Latina en el periodo de 1990 -1992 en el que el aporte fue del 38,1% (22), otra contribución importante fue el de las leguminosas en un 15,9%, esto sugiere que los hogares invierten más dinero en estos alimentos por ser menos costosos, pero esto a su vez implicaría un incremento ...
Objetivo: establecer la canasta básica recomendada de alimentos para los hogares de la región del Suroeste Antioqueño. Metodología Tipo de estudio: descriptivo de prevalencia. Muestra: representativa de hogares y municipios, con un nivel de confianza del 95% y un error del 10%. Constituida por siete municipios, 14 veredas y 241 hogares distribuidos en la zona urbana y rural. Métodos: a partir de la disponibilidad de alimentos en el hogar, durante la semana anterior a la entrevista, se construyó la canasta real de alimentos. Se definió la dieta básica promedio y se estableció una nueva estructura energética que corrigiera algunas deficiencias alimentarías. Se calculó el Coeficiente de Engel y se recomendó el de los ingresos mínimos para los hogares de la región. Resultados: la canasta real de alimentos estuvo constituida por todos los grupos de alimentos y en su interior se encontró poca variedad. El 57,0% de la energía disponible provino de los cereales y los azucares. La canasta básica de alimentos recomendada corrige las deficiencias en la disponibilidad de: leche, frutas y verduras. Los hogares deben tener un ingreso mínimo de 2,1 Salarios Mínimos Legales Vigentes para Colombia en el año 2004. Conclusiones: el estudio revela la necesidad de una política de empleo, de desarrollo social y económico de la región, para que los hogares puedan tener ingreso que les permita adquirir por lo menos la canasta de alimentos básica recomendada, como un principio de justicia social.
... The intervention did, however, have positive and statistically significant impacts on the dietary diversity of women and children. Healthy diets are important outcomes in and of themselves; they are a key factor affecting nutritional status (including child linear growth and reduced risk of malnutrition), micronutrient adequacy and reduced risk of morbidity and mortality from non-communicable diseases, and are important 'doubleduty' actions -those that simultaneously affect both under-and over-nutrition (Arimond & Ruel, 2004;Arimond et al., 2010;Grosso, 2019;Hawkes et al., 2019;Headey et al., 2018;Ruel, 2003). Improvements in diets for women and children in our sample come primarily from the fruit, dairy, and vegetable food groups. ...
... We also found that household dietary diversity scores were associated with increased odds of intrahousehold DBM. This finding is contrary to our expectations, as the HDDS is often viewed as an indicator of a household's economic ability to access food [38] and diversity is often seen as a key component of healthy diets [53]. While the HDDS is not intended as a proxy for dietary quality [38], studies elsewhere have established a positive association between household diet diversity and healthy diets [54], food security [55], and nutrition outcomes [56]. ...
Background:
In the Philippines, the rising prevalence of obesity and related chronic diseases alongside persistent undernutrition presents a complex public health challenge. Understanding the patterns and dynamics of this 'double burden of malnutrition' (DBM) is crucial for developing effective intervention strategies. However, evidence of the occurrence of undernutrition and overnutrition within the same household is currently lacking.
Methods:
Using cross-sectional data from the 2013 Philippines National Nutrition Survey this study examined the prevalence of different typologies of household-level DBM from an analytical sample of 5,837 households and 25,417 individuals. Multivariable logistic regression was performed to identify factors associated with overall occurrence of intrahousehold DBM.
Results:
The overall prevalence of double burden households was 56% based on a comprehensive definition. The most common typology of intrahousehold DBM characterized in this study (% of all households) comprised households with at least one adult with overnutrition and at least one separate adult with undernutrition. Household size, wealth quintile, food insecurity, and household dietary diversity were all associated with household-level DBM. Double burden households were also influenced by head of household characteristics, including sex, level of education, employment status, and age.
Conclusions:
The findings from this study reveal that the coexistence of overnutrition and undernutrition at the household level is a major public health concern in the Philippines. Further comprehensive assessments of household-level manifestations of the DBM are needed to improve our understanding of the trends and drivers of this phenomenon in order to develop better targeted interventions.
... In this case study, CHWs monitored children's growth and development using a mobile app and the project team established a local EHR database. Rwanda is battling child malnutrition as the research by World Bank found that in Rwanda 44% of children under five years of age suffer from stunting (Ruel, 2002;Schnepf, 1992). The goal of the study was to collect data that would inform researchers on the causes of stunting in Rwanda and help ameliorate the problem (Brown & McSharry, 2016). ...
Data collection in resource-constrained environments, particularly in the Global South, is challenging for a variety of philosophical, theoretical, methodological, and ethical reasons. Challenges may involve using research approaches designed in the Global North that are not appropriate when using data from the social and cultural contexts in the Global South. Adopting a reflective approach, this paper examines research projects in Bangladesh, Malawi, Sierra Leone, and Rwanda and highlights the challenges encountered on these projects. Along with the problems, attempted ameliorations are discussed, and insights are offered on how the authors overcame these challenges. The paper posits that these challenges can be mitigated by adopting contextualist methodology resulting in theories that are based on local social and cultural processes. The paper proposes that a critical realist-philosophical approach and methodology are appropriate because of contextual specificity and the innate ability to alleviate problems associated with the Global North methodology and generalisable theory.
... In our sample, the foods most commonly responsible for food allergies were tree nuts, milk and eggs, while only 13 children were allergic to fruit and/or vegetables. We hypothesize that the reduced antioxidant potential of the diet might be related to a reduced variety of the diet itself, intended as a reduced number of different food or food groups consumed over a specific reference period (38,39). ...
A reduced fruit and vegetable consumption, which implies a decreased intake of antioxidant compounds, seems to play a role in allergic diseases onset. Data on the antioxidant capacity of diet in children with food allergies, who are on an avoidance diet, are still lacking. This pilot study aims to assess the antioxidant potential of diet in Italian children with food allergies, compared to healthy children, using the oxygen radical absorbance capacity (ORAC) method. 95 children (54 with confirmed food allergies and 41 controls), with a median age of 7.8 years, were enrolled and underwent a nutritional assessment. Mean nutrient intakes were compared using the Mann–Whitney test. ORAC resulted significantly lower in allergic children (median 2,908, IQR: 1450;4,716) compared to control children (median 4,392, IQR: 2523;5,836; p = 0.049). Among micronutrients with antioxidant properties, vitamin A intakes were significantly higher in controls than in allergic children. Using Spearman’s correlation, a moderate-to-strong correlation between ORAC and vitamin C, potassium and magnesium was observed (ρ = 0.648, p < 0.001; ρ = 0.645, p < 0.001; ρ = 0.500, p < 0.001, respectively). Iron, phosphorus, vitamin E and vitamin A intakes were also moderately-to-low correlated with ORAC values (ρ = 0.351, p < 0.001; ρ = 0.367, p < 0.001; ρ = 0.346, p < 0.001; and ρ = 0.295, p = 0.004, respectively). We hypothesize that the reduced antioxidant potential of the diet might be related to a reduced variety of the diet in children with food allergies. Our study suggests that the diet of children with food allergies has a lower antioxidant potential (expressed as ORAC value) compared to the diet of healthy children, regardless of the allergenic food excluded from the diet. This issue should be further investigated in prospective, powered studies.
... The quality of diet during early childhood is a critical determinant of child's growth and development (Kuklina et al., 2004;Ruel, 2003;Miller et al., 2020;Prado et al., 2017). International guidelines recommend that children aged 6-23 months should continue to breastfeed and are introduced to age-appropriate complementary foods from diverse food groups (World Health Organization, 2003). ...
This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6-23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6-11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin-A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.
... Nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) for micronutrients in this study are commonly used measures of dietary quality [43][44][45][46][47] . The median NAR of energy, fat, carbohydrates, zinc, iron, and vitamin C were low. ...
Women sustain household health by operationalizing and maximizing nutrition through food preparation. Thus, information and the women's knowledge on nutrient adequacy of meals prepared at home is crucial for the design, implementation and performance of nutrition interventions. However, there is limited evidence on the adequacy of homemade complementary meals for children below two years in Tanzania. This study aimed to assess the dietary quality of the prepared complementary foods provided to infants and children. A cross-sectional survey was used to collect demographic and nutritional information. A total of 119 breastfeeding children aged 6 to 22 months were recruited. The dietary intake patterns were assessed using a seven-day food frequency questionnaire, and a 3-day 24 h recall. The dietary diversity score and Food consumption score evaluated dietary patterns. Food consumed by 27 children in a day (24 h) was weighed and recorded and samples were collected for nutrient analysis. Nutrient adequacy ratios were obtained by comparing FAO/WHO recommended intakes. Results revealed that 15% of the children had poor food consumption patterns. The median dietary diversity score of the children was four out of eight food groups. For most households, median adequacy ratios for energy, fat and micronutrient contributed from complementary foods were less than one. Although breastfeeding was present and supported at home, the nutrient densities of complementary meals were inadequate to achieve the WHO/FAO recommended nutrient intakes. Promotion of community food fortification and diversification programs, along with nutrition education, health and sanitation are necessary as they can improve the intake of critical micronutrients and nutrition status.
... Diet mostly based on plants is seldom enough to provide balanced nutrients because there are chemical substances in plants such as phytate, oxalate, and polyphenols that obstruct the absorption of minerals in the alimentary canal [39,40]. Since deficiency of main nutrients in a basic stage of the lifecycle will be carried to the next stage in the life cycle [41], the WHO to improve micronutrient intake recommended the intake of nutrient-rich foods such as animal foods or foods fortified with micronutrients [42]. Lack of DD is a considerable problem among poor populations in the developing world because their diets are predominantly of starchy staples and few fresh fruits and vegetables with little or no animal products [43]. ...
Backgrounds
Undiversified and monotonous diets can lead to deficiency disease, named micronutrient deficiency, more specifically among young children. Dietary diversity (DD) has been known as a valid indicator to assess micronutrient inadequacy of the diet. The aim of this study was to determine “is there an association between high dietary diversity and the micronutrient adequacy, in children under 5 years old?”.
Methods
PubMed, Scopus, ScienceDirect, Web of Sciences, and Google Scholar databases were searched until February 2022, without date restrictions, using relevant keywords. All original articles, written in English, evaluating the relationship between DD and micronutrient adequacy in children under 5 years were eligible for this review.
Results
Totally, 1814 records were found in electronic search databases; after removing duplicated and irrelevant studies according to the title and abstract, the full text of the 35 articles was critically screened, in which 15 cross-sectional studies were included in this review. All of these studies reported that DD of infants and children under 5 years was positively associated with their micronutrient adequacy.
Conclusion
The findings indicate that in infants and children under 5 years, intake of various food groups reveals the adequate intake of micronutrients.
... Menurut Ruel (2003), keberagaman pangan keluarga dipengaruhi oleh status sosial, ekonomi, dan budaya masyarakat. Tidak beragamnya konsumsi pangan merupakan salah satu penyebab terjadinya berbagai masalah kesehatan pada masyarakat dengan status ekonomi yang rendah di berbagai negara berkembang. ...
Masalah gizi yang terjadi pada masa tertentu akan menimbulkan masalah pembangunan dimasa yang akan datang. Keterlambatan dalam memberikan pelayanan gizi akan berakibat kerusakan yang sulit dan bahkan mungkin tidak dapat ditolong. Oleh karena itu, usaha-usaha peningkatan gizi terutama harus ditunjukkan pada bayi atau anak balita dan ibu hamil. Penelitian ini bertujuan untuk mengetahui konsumsi pangan, pengeluaran pangan dan pengetahuan gizi ibu rumah tangga dan mengetahui pengaruh konsumsi pangan, pengeluaran pangan dan pengetahuan gizi ibu terhadap kejadian stunting pada balita. Penelitian ini dilaksanakan pada rumah tangga di wilayah pinggirann sungai Kalimantan Selatan. Jenis penelitian asosiatif, dengan menggunakan metode wawancara dan analisis regresi linier berganda. Hasil penelitian menunjukkan dari 180 sampel rumah tangga, 102 responden (55,66%) dengan kategori konsumsi pangan beragam dan 78 responden (43,33%) dengan kategori konsumsi pangan tidak beragam. Selanjutnya untuk pengeluaran pangan terdapat 120 responden (66,67%) termasuk kedalam kategori proporsi pengeluaran pangan rendah dan 60 responden (33,33%) termasuk kedalam kategori proporsi pengeluaran pangan tinggi. Pengetahuan ibu tentang gizi menunjukkan 92 responden (51,11%) dengan kategori pengetahuan cukup, dan 88 responden (48,88%) pengetahuan baik. Dan hanya variabel konsumsi pangan berpengaruh dominan terhadap kejadian stunting balita yang bermukim pada rumah tangga di wilayah pinggiran sungai.
... Rural dwellers tend to rely on their own gardens and supplies came from social assistance programs or in other households. It was also suggested that food insecurity was slightly higher in urban areas than in the countryside (Garrett and Ruel 2000;Ruel 2003). ...
Across the globe, millions of people are experiencing poverty that further deteriorates the food security of the population. In the Philippines alone, millions of children were suffering from inadequate food intake and undernourishment. Dilemmas concerning household food insecurity continuously impose threats in the growth of children. This study aimed to determine the association of household food insecurity with underweight among preschool children in Occidental Mindoro. Specifically, it estimates the prevalence of household food insecurity, less diverse diet, and underweight among preschool children. This study utilized analytical, cross-sectional design whereas three multi-stage, systematic simple random sampling design was used to select the 480 preschool children. The Radimer-Cornell tool and child growth standards were used to assess household food security status and weight-for-age status of children, respectively. Multiple logistic regression was used to answer the major objective. The prevalence of household food insecurity was recorded at 51.0% (95% CI: 46.6–55.5%). Meanwhile, the prevalence of less diverse diet among preschool children was 31.7% (95% CI: 27.5–35.8%) and underweight was 30.2% (95% CI: 26.3–34.6%). After controlling the confounding effect of a less diverse diet, it was found that the odds of being underweight among preschool children were seven times higher if a household was food insecure (OR: 7.1, 95% CI: 4.2–11.8). Prevalence of household food insecurity, less diverse diet, and underweight among preschool children were found to be high in Occidental Mindoro. After controlling the effect of a less diverse diet, the odds of having an underweight child were 86% lower if the household was food secure.
... Moreover, the HDDS do not account for the portion size of the food consumed and could lead to overestimating the intake of a particular food or food (Ruel, 2003). We complement HDDS with the subjective self-evaluation of the household food security in the last seven days to capture the psychosocial part of food insecurity. ...
We examine food and nutrition security and the household’s ability to respond adequately to shock and stressors during the COVID-19 pandemic. Specifically, we assess household resilience to food insecurity and its relation to future food security. We use two survey rounds collected during the pandemic – before and after the second wave of the pandemic–from the vulnerable population living in slums in Tanzania. The findings reveal that many households have low resilience to shock. We find that COVID-19 reduced access to food in 68% of the households and left about 30% without any food to eat. We also find that micronutrient consumption significantly declined among households who reported food insecurity following the second wave of COVID-19. We also find that the probability of experiencing food insecurity reduced with the initial resilience level. High resilient households have a higher likelihood of maintaining or diversifying more their diets even when are exposed to shock. The disruption of income-generating activities was found as a leading pathway through which COVID-19 affected household food security. The findings suggest that with persisting COVID-19 pandemic and the low level of micronutrients consumption, the nutrition of children and adult household members of the vulnerable population is at stake.
... The European Academy of Allergy and Clinical Immunology (EAACI) emphasized that the inadequacy of the nutritional variety defined as the numerical and ideal consumption frequency of food groups consisting of different foods in infancy results in allergies seen in childhood (Ruel, 2003;Venter, 2020). In studies related to the prevention of childhood allergies, it has been understood that the effect of dietary diversity on the microbiome and immune system may affect allergy outcomes and it has been found that this change in the immune system is associated with several immune antigen tolerance mechanisms, including regulatory T and B cells, immune regulatory cytokines and suppressed IgE antibodies, as shown in other allergen tolerance models (Venter, 2020;Rivas, 2016;Palomares, 2017). ...
... Diet is an important environmental factor in early life, which influences the development of allergic diseases. [1][2][3][4] Food diversity, defined as the number of different food groups consumed over a given period, 5 may affect the development of immune tolerance via effect on the gut microbiome. Increased food diversity in infants during the complementary feeding period was associated with increased gut microbial diversity, 6 which was related to reduced allergic sensitization and allergy outcomes in children. ...
Background
The evidence on the relationship between diet diversity in early life and allergic outcomes was few and inconsistent. We sought to determine the association of food diversity in the first year of life with allergic outcomes in the second year.
Methods
Two thousand two hundred fifty‐one mother‐infant pairs from Tongji Maternal and Child Health Cohort (TMCHC) were involved in the study. Information on complementary foods introduction was obtained by telephone interview at 6‐ and 12‐month postpartum follow‐up. Any doctor‐diagnosed allergic diseases in the second year were recorded at 2‐year postpartum follow‐up. Food allergies in infancy were assessed and self‐reported by mothers at each postpartum follow‐up. Multivariable logistic regression was used to examine the effect of food diversity at 6 and 12 months of age on later allergic diseases and food allergy.
Results
A total of 135 (6.0%) infants reported allergic diseases at between 1 and 2 years of age. Independent of food allergy history of infants and other potential confounders, less food diversity at 6 months of age was associated with increased risk of later allergic diseases (OR 2.17, 95% CI 1.04–4.50 for 0 vs. 3–6 food groups). By 12 months of age, significant inverse associations with later allergic diseases (OR 2.35, 95% CI 1.03–5.32 for 1–5 vs. 8–11 food groups, and OR 1.98, 95% CI 1.16–3.37 for 6–7 vs. 8–11 food groups) and food allergy (OR 2.10, 95% CI 1.29–3.42 for 1–5 vs. 8–11 food groups) were observed. Children with higher food diversity in both periods had the lowest risk of allergic diseases during the second year of life.
Conclusions
A more diverse diet within the first year of life was associated with reduced risk of allergic diseases at 1–2 years of age. Introducing higher diversity of foods from 6 to 12 months of age might be an effective strategy to improve the allergy outcomes of infants in later life.
... Following FAO [8], food groups 3 and 4 (legume, nut and seed) and 7 and 8 (meat) were aggregated to create dietary diversity scores (DDS) of the households, which ranged between 0 and 12, as summarised in Table 1. It should be noted that there is no international consensus on which food groups to include in the scores; rather, the selection of food groups should be driven by the specific purpose that the dietary diversity indicator is to be used for [8,18]. Each food group has a range of food items that are consumed in the study area for which the households have to indicate the frequency of eating in the last 7 days preceding the survey. ...
The diets of many households in developing countries are monotonous and starch-based.
Integrating underutilised indigenous vegetables (UIVs) to cropping systems can contribute to both crop and dietary diversities, thereby improving rural households’ nutrition and boosting food security. Therefore, this study established a link between the UIVs’ diversity and the household dietary diversity (HDD) of the UIVs producers in the rural area of Southwest Nigeria. A multistage sampling technique was used to select 191 UIV-producing households in the region. Their HDD was measured based on the 12 unique food groups consumed by households over a 7-day reference period preceding the survey, and negative binomial Poisson regression analysis was used to determine the relationship between UIV diversities, other sociodemographic characteristics, and the HDD score of the UIV-producing households in the area. The results showed that only about four groups of food contributed greatly to the HDD score. The result of the negative binomial Poisson regression analysis showed UIVs diversity as a significant variable that increased the HDD score in the study area. Other factors that determined the HDD score of UIV-producing households were the marital status of the household head, farm distance from the home, UIVs land area, off-farm income, UIVs gross margin, per capita food expenditure, and Oyo location. The study concluded that the inclusion of diverse underutilised indigenous vegetables into cropping systems in rural areas and vegetable home gardening practices in the rural and urban areas of developing countries could alleviate the challenge of nutrition insecurity
... As with other countries, family food baskets become more balanced with improved socioeconomic status in both urban and rural areas across seasons (Ruel, 2002). Food taboos imposed by cultural and religious beliefs restrict the consumption and use of certain foods in all country contexts (Forsythe et al., 2015). ...
• Animal-sourced foods make a valuable contribution to the diets of consumers from countries across the economic development spectrum. They provide essential micronutrients including iron, vitamin A, vitamin B12, iodine, and zinc, to balance diets which, apart from vitamin B12, are more bioavailable than in plantsourced foods. This is important for consumers with high needs including young children, pregnant and lactating women, and malnourished people.
• Although international trade has great potential to distribute animal products to satisfy global food demand, current trade flows are not achieving this goal in many low and lower middle-income countries. Multilateral efforts, supported by high-income countries, are needed to orientate international trade systems to provide better food and nutrition security.
• The continuity of trade in filling nutrient deficiencies is often disrupted in times of economic depression, conflict, or natural disaster. Suppliers can retain food resources for their own consumers, while in low-income countries most consumers can ill-afford expensive imports.
• Stability in most countries’ supply of animal-sourced foods must rely on the resourcefulness of domestic family-based farmers, who produce up to 80% of the world’s food.
• While encouraging the international trade of animalsourced foods, governments need to ensure that they develop policies that support these local production units to remain profitable to meet domestic consumption needs.
• These policies must be developed in the context of the UN’s doctrine of a Right to Food designed to ensure individual countries provide good governance and resources to minimize hunger and poverty.
... First, let us consider map (3) for a hypothetical country (see Figure 3). This map indicates that many households in region A, 8 Apart from being derived at the household level, the NHA measure fully aligns with the so-called "nutrient adequacy ratio," which is the more commonly used term for this measure of dietary quality and typically applies to individuals (Ruel, 2002). The truncation function assures that households with a surplus intake for a particular nutrient cannot compensate for deficient intakes observed in other households within the same sub-region. ...
Motivation
Spatial variation in crop and livestock production, combined with variation in market purchases and food transfers, lead to geographic differences in malnutrition that can inform food system policies.
Purpose
This paper quantifies nutrient production and consumption by sub-region in Uganda, to identify the magnitude and location of gaps left by farm households’ own production, market purchases and food transfers relative to household nutrient requirements.
Methods and approach
Using the fourth round of Uganda’s National Panel Survey (2013/14), we convert households’ food production and consumption to nutrient equivalents, then identify the spatial pattern of nutrient inadequacy relative to requirements in each sub-region. To inform policy, we identify the main food sources of five key micronutrients as well as their least-cost alternatives to fill corresponding gaps.
Findings
Sufficient calories and protein are generally available from farm production, purchases and transfers, but alarming deficits can be seen in the supply of calcium, iron and zinc as well as vitamins A and B12. Deficits are especially marked in the North East sub-region. A variety of foods currently available in small quantities could be scaled up to fill these gaps.
We find severe limitations in the available data, however, revealing the need for future work to cover all nutrient sources throughout the year with sufficient spatial and temporal precision to target interventions.
Policy implications
The data analysed provide a suggestive but incomplete picture of how farm production, food markets and transfers could be enhanced to meet nutrient requirements. Candidate foods for production and marketing to fill nutrient gaps include diverse vegetal crops, milk and fish. Perishability, transport and high production costs currently limit supply while low incomes limit demand, implying that a variety of food system interventions as well as social protection transfers are needed to fight hidden hunger in Uganda.
Low dietary diversity (LDD) is prevalent among vulnerable populations, posing a morbidity risk. Few studies have been conducted on the dietary diversity of migrants. The objectives of this study are to determine the prevalence of LDD among migrants in Morocco and the risk factors associated with it. In the Oriental region, we conducted a cross-sectional study with migrants between November and December 2021. The sampling method used was convenience sampling. A face-to-face, structured questionnaire was used to collect sociodemographic, behavioral, and clinical data. We calculated a dietary diversity score based on a 24-h food recall and assessed food intake. The risk factors associated with LDD were identified using multivariate logistic regression. A total of 445 migrants was enrolled. The prevalence of LDD was 31.7%. Risk factors associated with LDD were: being homeless (adjusted Odds Ratio (AOR) of 6.32; CI% [3.55–11.25]), a lack of social support (AOR of 2.30; CI% [1.33–03.98]), and low monthly income (AOR of 8.21; CI% [3.39–19.85]). Public policies must focus on social and environmental determinants. Nutrition training programs should be set up for the migrant population.
Dietary diversity (DD) plays a crucial role in fostering high-quality diets, but its association with health outcomes, particularly body adiposity and non-communicable diseases (NCDs), is inconsistent. This may be due to a lack of a standardized method for estimating DD. Our study investigates the association between two DD indices, namely the dietary diversity score (DDS) and food variety score (FVS), and anthropometric measures, biochemical parameters, and diet quality in a large population sample from the I.Family study across research centers in eight European countries. In our cross-sectional analysis of 3035 participants, DDSs varied among countries, with a higher prevalence in the third DDS tertile among those with higher education. DDS showed a positive association with diet quality across all age groups. Higher DDS tertile individuals showed increased fiber, fruit, and vegetable intake, greater meal frequency, and lower ultra-processed food consumption. No relevant biochemical differences were observed across DDS tertiles, and a higher DDS was associated with lower overweight/obesity prevalence only in adults. No significant associations were found with FVS. Our findings emphasize the need to consider food groups for a more accurate estimation of diet quality. This aligns with studies suggesting DDS alone is not an independent risk factor for obesity in children and adolescents. Public health programs should prioritize food diversity to promote improved nutrition and overall well-being in communities.
Diet diversity is a term used to define the number of foods or food groups eaten over a certain period. In turn, diet quality describes food patterns and is usually summarised by using diet indices. There are a wide range of dietary and environmental aspects that have been associated with the patho-ethiology of allergic diseases. One of the factors includes nutrition of the pregnant and breast feeding women, infant and child. Studies focusing on the intake of specific nutrients have failed to provide any clear guidance on allergy prevention. Allergen avoidance for the pregnant and breast feeding women is not recommended and timely introduction and consumption of food allergens when infants start to eat is recommended. Nutritional prevention strategies have shifted their focus from single nutrients and foods to addressing the to the overall during pregnancy, breast feeding, and early life. Only one diet index in pregnancy, as a measure of the overall diet, has shown a reduction in childhood allergic disease, referred to as the maternal diet index. Limited data exist to support the role of the Mediterranean diet in pregnancy and offspring respiratory outcomes. There no studies focusing on diet indices in infancy and childhood allergy outcomes. Infant diet diversity and maternal healthy diet diversity during pregnancy has been associated with a reduced prevalence of childhood allergic diseases. There is a need to perform randomised controlled trials using overall dietary intake to support international food allergy guidelines.
The relative research on investigating the association between dietary diversity scores and anthropometric status among young children is few and inconsistent. Since understanding this association is quite essential to give more detailed advice about diet to ensure young children's healthy growth, we sought to determine the association between dietary diversity levels and anthropometric status among young children under 24 months. The study included 1408 mother−child pairs from the Tongji Maternal and Child Health Cohort, whose children range in age from 12 to 24 months. Multivariable logistic regressions were used to examine the effect of dietary diversity on children's anthropometric failure and obesity. All obese children aged 12 and 24 months had low‐medium diverse diets in their first year of life. Risks of anthropometric failure for 12‐month young children consumed low‐medium diverse diets in their first year and 24‐month young children consumed low‐medium diverse diets in their second year are, respectively, 1.27 (odds ratio [OR], 95% confidence interval [CI] = [1.06−1.53]) and 1.19 (OR, 95% CI = [1.02−1.40]) times of those who consumed high diverse diets in corresponding year. The risk of anthropometric failure for 24‐month‐old children who consumed low‐medium diverse diets during their first year of life is 4.70 (OR, 95% CI = [1.62−19.91]) times that of young children who consumed highly diverse diets during their first year of life. Introducing more diverse diets to young children under 24 months of age may be an effective strategy to prevent anthropometric failure and obesity in young children in later life.
Background:
Dietary diversity is important for pregnant women since it has been associated with nutrient adequacy. It is very crucial to ensure optimal fetal health and development. There is no evidence at the community level on the magnitude of dietary diversity and its predictors among pregnant women in okra-producing areas of western Ethiopia.
Objective:
This study aimed to assess the level of dietary diversity and its associated factors among pregnant women.
Design:
A community-based cross-sectional study was employed among randomly selected 224 pregnant women in western Ethiopia. An interviewer-administered questionnaire was used to collect the data. The qualitative open 24-h recall was used to assess the level of dietary diversity. Ordinal logistic regression analyses were used by SPSS version 25. An adjusted proportional odds ratio along with a 95% confidence interval [CI] was computed to measure the strengths of the association at a P ≤ 0.05.
Result:
This study revealed that more than one-fourth, 64 (28.6%), of the respondents were found to have high dietary diversity scores. Antenatal Care [ANC] visits (Adjusted Odds Ratio [AOR] = 2.10, [95% CI: 1.13, 3.90], P = 0.01), changing food intake (AOR = 2.97, [95% CI: 1.16, 3.67], P = 0.002), and being food secure household (AOR = 2.63, [95% CI: 1.38, 5.00], P = 0.003) were significantly associated with a higher probability of having high dietary diversity score. However, lack of formal education (AOR = 0.34, [95% CI: 0.61, 0.89]) was inversely associated with the probability of having high dietary diversity.
Conclusion:
More than half of pregnant women in western Ethiopia were found to have low dietary diversity. Therefore, ANC follow-up, dietary modification, and promotion of frequent use of wild edible plants (okra) to maintain household food security were very crucial.
Background:
Breastmilk is considered the optimal source of nutrition for infants. However, recommendations and practices for when and how complementary food should be introduced in the first year of life vary worldwide. Early introduction of allergenic foods may prevent food allergies, but if early food introduction influences infant feeding practices is less known.
Objective:
The aim of this population-based clinical trial was to assess infant feeding practices in the first year of life and to determine if early interventional food introduction influences breastfeeding and dietary diversity.
Methods:
Dietary intake was assessed in infants from the Preventing Atopic Dermatitis and ALLergies (PreventADALL) in children study. A total of 2397 infants were cluster-randomized at birth into four different groups: (1) control, (2) skin intervention, (3) introduction to four allergenic foods between 3-4 months of age: peanut, cow´s milk, wheat, and egg, as small tastings until 6 months, and (4) combined skin- and food interventions. Dietary data were available from at least one of the 3-, 6-, 9- and 12-month questionnaires in 2059 infants. In the present analysis, group (1) and (2) constitutes the No Food Intervention group, whereas group (3) and (4) constitutes the Food Intervention group. We used the log-rank test and Cox regression to assess the impact of food intervention on age of breastfeeding cessation. Mixed effects logistic regression was used to compare dietary diversity, defined as the number of food categories consumed, between intervention groups.
Results:
At 3, 6, 9, and 12 months, 95%, 88%, 67%, and 51% were breastfed, respectively, and breastfeeding duration was not affected by the food intervention. In the No Food Intervention group mean age of complementary food introduction was 18.3 weeks (CI 18.1-18.5). In the Food Intervention group, the dietary diversity score was 1.39 units (CI 1.16-1.62) higher at 9 months (p < 0.001) and 0.7 units (CI 0.5-0.9) higher at 12 months (p < 0.001) compared to the No Food Intervention group.
Conclusion:
Early food intervention did not affect breastfeeding rates and increased dietary diversity at 9 and 12 months.
Background
Hypertension is highly prevalent in India; however, little is known about the dietary intakes of those living with hypertension, particularly in rural areas. The primary aim was to assess the dietary intakes of individuals living in rural India with self-reported history of hypertension. As secondary analyses, we explored the dietary impact of a salt substitute in this population group.
Materials and methods
This study used data from a large randomised controlled trial conducted in seven villages across rural India. Participants received either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride) to replace all home salt use. Dietary intake at baseline and end-of-trial was assessed using 24-h dietary recalls. A range of dietary outcomes were assessed including energy intake, macronutrient intake and overall diet quality according to the Alternate Healthy Eating Index (AHEI).
Results
A total of 454 participants were included in the analysis. At baseline, mean (SE) energy intakes in regular salt group and salt substitute group were similar at 5240 (110) kJ/day and 5120 (106) kJ/day, respectively. This was largely attributable to intakes of carbohydrates (74.4% of total energy intakes for regular salt group vs 75.4% for the salt substitute group) followed by total fat (15.8% vs 15.4%) and protein (10.4% vs 10.3%). Both groups also had similar AHEI scores at baseline, with mean (SE) total scores equating to 33.0 (0.4) (out of a total 90) for the regular salt group and 32.7 (0.4) for the salt substitute group. Both groups received lowest AHEI scores across the following components: vegetables, fruit and wholegrains. At baseline, the mean (SE) intakes of sodium across the regular salt and salt substitute groups were similar at 2349 (67) mg/day and 2396 (64) mg/day, respectively. In the salt substitute group, there was a significant reduction in total sodium intakes over time (−264 mg/day, 95% CI, −442 to −85), driven by the use of the salt substitute.
Conclusion
This study found individuals with hypertension living in rural India had poor dietary intakes, including low intakes of fruits, vegetables and wholegrains, and high intakes of sodium. Salt substitutes may be an effective strategy for reducing sodium intake in this population group.
Résumé
Le bradage massif des produits agricoles en période de récolte constitue l’un des problèmes auxquels sont confrontés les ménages agricoles. Cette situation maintient ces derniers dans un cercle vicieux de faibles revenus et constitue une véritable menace pour leur sécurité alimentaire. Le warrantage a été l’un des mécanismes développés pour aider les producteurs à mieux organiser la mise sur le marché de leur production et améliorer leur revenu et la sécurité alimentaire de leurs ménages. Ainsi, l’objectif de l’étude était d’évaluer l’impact du warrantage sur l’accès aux aliments des ménages des producteurs de maïs dans le département du Borgou. Elle a été conduite sur un échantillon aléatoire stratifié de 314 producteurs de maïs dont 157 participants au warrantage et 157 non participants. L’indicateur utilisé à cet effet a été le Score de Diversité Alimentaire des Ménages (SDAM). L’appariement par les scores depropension a été la méthode d’impact utilisée. Sans l’appariement, les résultats ont montré que lesménages ont consommé en moyenne 6,50 groupes d’aliments sur 12 dont 6,78 groupes pour les ménages des bénéficiaires contre 6,23 groupes pour les ménages des non bénéficiaires avec une différence significative (p ˂ 0,01) de 0,55 point entre les deux groupes de ménages. La méthode d’appariement, qui permet de construire deux groupes comparables, a confirmé que le warrantage a effectivement accru significativement (p ˂ 0,01) le score de diversité alimentaire des ménages de 0,42 point. Ce faible impact du warrantage sur l’accès aux aliments/produits alimentaires suggère que sa mise en oeuvre soit accompagnée des sensibilisations des bénéficiaires sur l’importance d’une alimentation variée et équilibrée afin d’améliorer l’accès des ménages agricoles dans le département du Borgou à une alimentation diversifiée.
Mots clés : Diversité alimentaire, crédit agricole, appariement, Kalalé.
Abstract
One of the problems facing farm households is the massive sale of agri-food products during harvest period. This situation keeps them in a circle of low income and constitutes a real threat to their food security. Warrantage has been one of the mechanisms developed to help producers better organize the marketing of their production and improve their income and household food security. Therefore, the objective of this study was to assess the impact of warrantage on access to food for households of maize producers in the department of Borgou. It was conducted on a stratified random sample of 314 maize producers, 157 of whom were participants in warrantage and 157 of non-participants. The indicator used for this purpose was the Household Dietary Diversity Score (HFDS). The propensity scores matching was the impact evaluation method used. Before matching, the results showed that households consumed on average 6.50 food groups out of 12, including 6.78 groups for beneficiary households against 6.23 groups for non-beneficiary households with a significant difference (p ˂ 0.01) by 0.55 point between the two groups of households. The propensity scores matching, which makes it possible to build two comparable groups, confirmed that warrantage significantly increased (p ˂ 0.01) the household dietary diversity score by 0.42 point. This weak impact of warrantage on food security suggests that its implementation should be accompanied awareness-raising for beneficiaries on the importance of a varied and balanced diet in order to improve access to a diversified diet for agricultural households in Borgou.
Key words: food diversity, agricultural credit, matching, Kalalé.
Objective
Vitamin A deficiency (VAD) has serious public health consequences including morbidity and mortality for populations in low and middle-income countries (LMICs), especially for children under 5 years and pregnant women. LMICs are at greater risk of VAD, in part due to low levels of consumption of vitamin A-rich foods most of which are plant-based, such as orange-fleshed sweet potatoes (OFSP), with lower bioavailability than animal sources of the vitamin A. Food-based approaches such as biofortification of OFSP, including promoting the consumption of vitamin A-rich biofortified staple crops, has been shown to be potentially effective in improving the status of vitamin A and other micronutrients. This study examined vitamin A-rich food consumption and its predictors among women of reproductive age from OFSP-growing households in two regions of Uganda.
Methods
A cross-sectional survey was conducted among 617 OFSP growing households, focusing on women in the reproductive age group from the northern and eastern regions of Uganda. Households were not receiving any VAD-related intervention at the time of the survey. Quantitative data included vitamin A-rich food consumption, knowledge on vitamin A, and rich food sources dietary intake, using a 7-day food frequency questionnaire. Vitamin A consumption and risk of deficiency were estimated using the Hellen Keller International guide.
Results
The majority of women in this study were either pregnant (80%) or lactating (17%). More than 70% of the study population had a weighted vitamin A rich food consumption mean score of <6 days per week, indicating a high risk of VAD. Knowledge about vitamin A [b (SE) = −0.18 (0.50), p < 0.001] was significantly and inversely associated with vitamin A rich food consumption.
Conclusion
Components of food insecurity such as availability, affordability, utilization, and changing food preferences may contribute to the unexpected inverse relationship between knowledge and consumption of vitamin A rich foods. Scaling up biofortified food initiatives, including OFSP, can improve consumption of vitamin A rich foods with effective strategies to comprehensively address consumption barriers such as lack of nutrition education, cooking skills, and storage facilities, as well as low production levels and perceived contamination of biofortified foods.
Objective
This study aimed to identify the associated factors of low and medium household (HH) dietary diversity (DD) compared with high DD among marginalised households in rural Bangladesh.
Methods
Through the Suchana baseline survey, data on 5440 households from Sylhet and Moulvibazar districts of Bangladesh was collected between November 2016 and February 2017. Household DD was categorised as low, medium or high based on number of food groups consumed during the last 24 hours. Primary outcome measure was household DD; multinomial logistic regression was to determine independent correlations between outcome and independent variables.
Results
Of the households examined, 0.72%, 31.8% and 67.5% had low, medium and high DD, respectively. Around 99% and 97% of households consumed cereals and vegetables. Cereals, fruits and legumes accounted for 36%, 18% and 16% of total food expenditure; vegetables only represented 8% of total expenditure; 70% of total monthly expenditure was on food items. Compared with high DD, low DD was significantly associated with severe food insecurity, not receiving remittance, not being supported by social safety-net programs, household size of 6–10, household income and expenditure on food below-median. Severe food insecurity was the strongest predictor of low DD. Age, occupation and educational status of the household head, amount of land owned and presence of a homestead garden, fish production and domestic violence were not significantly associated with DD.
Conclusion
Our findings suggest that nine out of ten households were food insecure, and nearly two-thirds of households had high DD. Severe food insecurity was significantly associated with low DD. Expenditure on food items amounted to nearly two-thirds of total household expenditure. Diversification of income-generating activities would provide more sources of income to the households, allowing the households to spend more on non-cereal food items and increase the household dietary diversity.
Background
Diet diversification ensures nutritional security and hence helps to realize human nutrient requirements. Despite its importance, diet diversification remains a challenge especially for rural communities of the developing countries. This study was aimed to identify the determinants of diet diversity in Oromia, and in the Southern Nations, Nationalities and Peoples regions of Ethiopia.
Methods
The agriculture-nutrition household panel data, called Ag-Nutrition, is used in this paper. The study collected data in 1200 households twice a year for two years in two kebeles in each of ten woredas (districts). We used the previously introduced Household Dietary Diversity Score (HDDS). In addition to several potential demographic, social, economic and geographic determinants of diet diversity, we defined a new empowerment score of women in nutritional household decisions. Mixed effect truncated Poisson regression was fitted to determine possible determinants of diet diversity at household level.
Result
The value of the HDDS ranged from 1 to 10 with mean 5.52 and standard deviation (SD) 1.54. One unit increment in variety of crop production gave a 3.37% increase in HDDS (95% CI [1.93%, 4.88%]). A one-birr increase in income generated from livestock products resulted in 2.62% increase of HDDS ([1.54%, 3.72%]). The post harvesting season contributed with a 6.43% increase in HDDS relative to the pre-harvesting season ([3.61, 9.33]). Households headed by a woman were lower by 92.34% of HDDS relative to a man-led household ([87.46, 96.70]). An additional year of education of the household head resulted in 1.19% increase of HDDS ([0.73,1.66]. As the mean empowerment score of women increased by one score point, the increment in HDDS increased by 3.80% ([1.13, 6.39]). We found no significant effect of the vicinity of the households to local markets on the HDDS.
Conclusion
This study has identified economic, educational, social and seasonal factors associated with HDDS, which need to be taken into consideration when planning interventions aimed at improving HDDS in rural Ethiopia and possibly in other similar regions.
Background:
Diet diversity signifies the nutrient adequacy of an individual and thus has gained widespread significance in recent times. In developing countries achieving maximum diet diversity, especially among pregnant women from rural areas is challenging although of great importance. However, to do so understanding the primary factors associated with diet diversity is important. This paper, therefore, assessed the socio-demographic and socio-economic determinants of diet diversity among rural pregnant women in India.
Methods:
The study consisted of a community-based prospective cohort of n = 204 pregnant women attending primary healthcare centers (PHC) across 14 villages in Mulshi Taluka, Pune, Maharashtra, India. The data was collected using a structured questionnaire through a one-to-one interview method.
Results:
The prevalence of low, medium and high diet diversity was 56.4%, 33.3%, and 10.3% respectively. Minimum diversity in the diet was achieved among 73.5% of pregnant women. The mean diet diversity score (DDS) was 3.6 ± 1.3 with starchy staples being (100%) of commonly consumed foods. Young (< 20 years) women (OR = 5.2; CI:1.9- 13.8), housewives (OR = 3; CI:1.4-6.7), husbands working as skilled laborers (OR = 2.5; CI:1.2-5.5) were at significant risk of having low diet diversity scores. Whereas, those living in a joint family (OR = 0.3; CI:0.1-0.6), not owning a house (OR = 0.5; CI:0.2-0.9), and having a poor income (OR = 1.9; CI: 0.9- 3.7) were less likely to have low diet diversity.
Conclusion:
Socio-economic and demographic factors (maternal age, mother's occupation, and husband's occupation) influenced the diet diversity among pregnant women. Monotonous diets are commonly seen in developing countries, especially in rural areas which can be a risk factor for poor nutrient adequacy and health of pregnant women. Policies and programs about these determinants of diet diversity should be enacted to replace the poor quality diets to ensure improved diet diversity and nutrient adequacy.
Background:
The COVID-19 pandemic and countrywide lockdown could negatively impact household food insecurity among low-income households. This study aimed to investigate the prevalence of household food insecurity and its influencing factors among low-income people in Bangladesh during the lockdown of COVID-19.
Methods:
This cross-sectional study was conducted through face-to-face interviews from 500 low-income households during the countrywide COVID-19 lockdown. A pretested, structured and validated questionnaire was used to collect socioeconomic characteristics, household income conditions, and food accessibility. Household Food Insecurity Access Scale (HFIAS) and Dietary Diversity Score (DDS) were used to measure food insecurity. Multinomial logistic regression models were estimated to evaluate and predict risk factors that influence food insecurity.
Results:
The study found that above 67% of households was mild-to-moderate food insecure while 23% experienced severe food insecurity. Significantly, 88%, 97.4%, and 93.4% of the households had anxiety and uncertainty, inadequate quality, and inadequate quantity of food, respectively. The regression analysis revealed the age 36-50 years (RRR: 4.86; 95% CI: 2.31-7.44, RRR: 4.16; 95% CI: 2.25-6.10) and monthly income <58.3 USD (RRR: 3.04; 95% CI: 1.12-5.14, RRR: 3.26; 95% CI: 1.79-4.71) were significantly associated with food insecurity (p <0.001). Likewise, less-income (RRR: 3.87; 95% CI: 1.37-6.46, RRR: 2.99; 95% CI: 1.16-4.83), increase in food prices (RRR: 1.29; 95% CI: 0.32-2.33, RRR: 1.08; 95% CI: 0.05-1.12), and those who did not have same type of earning as before during the COVID-19 lockdown (RRR: 3.41; 95% CI: 1.33-5.62, RRR: 2.60; 95% CI: 0.99-4.24) were potential risk factor for MMFI and FI.
Conclusion:
This study found that households become more susceptible to food insecurity during the COVID-19 pandemic and lockdown period. Based on the findings, we suggest some essential food policies and adequate food assistance to mitigate these negative consequences.
Background:
Dietary diversification is considered the proxy indicator of dietary quality and nutrient adequacy during pregnancy. Pregnant women have been considered susceptible to malnutrition because of their increased nutrient demands and thus consuming a variety of foods in their diet plays a lion's role in ensuring adequate nutrient intake. So understanding bottleneck factors associated with dietary diversity practice is very crucial to encouraging adequate dietary diversity practice. Therefore, this paper aimed to assess determinants of dietary diversity practice among pregnant women in the Gurage zone, Southwest Ethiopia.
Methods:
A community-based cross-sectional analytical study was conducted among 726 pregnant women, 13 key informants, and 27 focus group discussion discussants in the Gurage zone, southwest Ethiopia, from 1 September to 1 November 2021. A face-to-face interviewer-administered questionnaire was used to collect the data. According to the Minimum Dietary Diversity Score for Women (MDD-W) tool, women who consumed more than or equal to 5 of 10 food groups in the previous 24 hours had a diverse diet. Epi data version 3.1 was used for data entry, while SPSSversion 26 was used for analysis. To determine factors associated with dietary diversity, bivariate and multivariable logistic regression models were used to obtain crude odds ratio (COR), adjusted odds ratios (AOR), and 95 percent confidence intervals (CIs). Statistical significance was determined using adjusted odds ratios (AORs) with 95 percent confidence intervals (CIs) and p values less than 0.05. In narrative form, qualitative results were triangulated with quantitative data.
Results:
The overall prevalence of the adequate dietary diversity practice was found to be 42.1% with 95% CI (48.4-46.1%) and the mean dietary diversity score was 5.30 ± 1.49 standard deviation (SD). Multivariable analysis revealed that primary school level [AOR = 6.471 (2.905, 12.415)], secondary school level (9-12) [AOR = 7.169 (4.001, 12.846)], college and above level [AOR = 32.27 (15.044, 69.221)], women with higher empowerment [AOR = 3.497 (2.301, 5.315)], women with a favorable attitude toward dietary diversity [AOR = 1.665 (1.095, 2.529)], women from wealthier households [AOR = 2.025 (1.252, 3.278)], and having well-secured food status [AOR = 3.216 (1.003, 10.308)] were variables that influence dietary diversity practice. Three FGD and 13 key informant interviews were conducted, and the results of qualitative data generated three major themes.
Conclusion:
The overall prevalence of adequate dietary diversity practice was found to be low in this study when compared to studies conducted in Ethiopia. Maternal educations, mothers' attitudes toward dietary diversity, women empowerment, food security status, and wealth index level of the household were determinant factors that influence dietary diversity practice in this study. Therefore, programs aimed to improve pregnant women's dietary diversity practice should focus on improving the socioeconomic status and creating a congenial environment to promote women's empowerment.
Abstract Background Pregnancy can aggravate nutritional deficiencies, especially micronutrient deficiencies, which can have major health impact for the fetus and mother. Women in low-income countries are frequently malnourished when they become pregnant. Identifying the magnitude of dietary diversity and its influencing factors among pregnant women in the pastoral region of Afar, where no study has been conducted, is critical for establishing an intervention program in the region. Method A mixed study comprising 241 pregnant women and six focus group discussions was conducted from October 1 to November 10, 2018. Participants in the quantitative study were selected by a systematic sampling method, whereas those in the focus group discussions were selected by a purposive sampling method. The data were collected using pretested questionnaires administered via face-to-face interviews. Logistic regression determines the association between the dietary diversity practice and its influencing factors. The results were presented by the odds ratio with a 95% confidence interval. A P-value of
Food insecurity exacerbates malnutrition with irreversible consequences for children. Thus, we address the determinants of food security status with reference to women farmers, the determinants of access to irrigation technology as a critical determinant of food security and the effect of cooperatives on nutritional status. We used primary data from Kakamega, Kenya. Descriptive data analysis was applied together with regression analysis using logistic, probit and linear endogenous treatment models. Cooperative membership facilitates female farmers’ access to productive resources like credit, thereby contributing to improved food security status. Though most female farmers are not members of cooperatives, the female members of cooperatives perform slightly better as determinants of food security status and are more food secure than female non-members. The limitations of cooperatives include the low percentage of farmers using irrigation and farmers’ low nutritional status. Extension services positively impact irrigation, thereby calling for gender equality among field officers to enable communication with female farmers and for the formation of cooperatives that target women's needs. Governments, development agencies and civil societies should support cooperatives in their financial, technical and management issues to create awareness concerning family planning and offer access to credit and irrigation technology, resulting in increased food production, improved food security and nutrition status.
Following a varied diet is associated with a healthier diet and a greater likelihood of incorporating the necessary micronutrients. The dietary diversity index (DDI) is the indicator that measures this variety, while the diet quality index (DQI) determines how much of this diversity consists of the inclusion of healthy foods. The aim of the study was to evaluate the quality and diversity of the diet of the Argentine population by identifying differences by sex, age, socioeconomic level, nutritional status and region. The sample consisted of 1266 subjects of urban population, of both sexes, between 15 and 65 years of age and of all socioeconomic levels. Anthropometric and intake assessment was performed, through 2 24-hour recalls. The DDI was assessed following the guidelines proposed in 2016 by Food and Agriculture Organization and the development of the DQI was performed following the methodology of Imamura y col. The DQI was relatively low, with a score of 63.9%. The DDI was 4.48 out of a maximum of 10, reflecting a poorly varied diet; additionally, only 50% of the population reported a varied diet. These indicators are significantly lower in people with low SEL. The DDI and the percentage of people with a diverse diet was higher in people from the metropolitan area of Buenos Aires. This study showed that the quality of the diet in the Argentine population is low and with a limited consumption of the food groups that provide the most micronutrients.
Resumen Una dieta variada se asocia a una mayor probabilidad de incorporar micronutrientes esenciales. El índice de diversidad de dieta (IDD) es el indicador que mide esta variedad, mientras que el índice de calidad de dieta (ICD) determina cuánto de esa diversidad refleja la inclusión de alimentos saludables. El objetivo del estudio fue evaluar la calidad y diversidad de la dieta de la población argentina identificando las diferencias por sexo, edad, nivel socioeconómico, estado nutricional y región. La muestra fue de 1266 sujetos de población urbana, de ambos sexos, entre 15 y 65 años y de todos los NSE. Se realizó una evaluación antropométrica y de la ingesta, a través de 2 recordatorios de 24 horas. El IDD se evaluó siguiendo las guías propuestas en el año 2016 por la Organización de las Naciones Unidas para la Alimentación y la Agricultura y el desarrollo del ICD se realizó siguiendo la metodología de Imamura y col. El ICD fue relativamente bajo, con un puntaje de 63.9%. El IDD fue de 4.48 de un máximo de 10, lo que refleja una dieta poca variada; adicionalmente, solo el 50% de la población informó una dieta variada. Estos indicadores fueron significativamente menores en las personas con bajo NSE. El IDD y el porcentaje de personas con dieta diversa fue mayor en los habitantes del área metropolitana de Buenos Aires. Este estudio evidenció que la calidad de la dieta en la población argentina es baja y con un consumo limitado de los grupos de alimentos que más aportan micronutrientes. Palabras clave: diversidad de la dieta, calidad de la dieta, consumo de alimentos, Argentina Abstract Diet quality and diversity in the urban population of Argentina. Following a varied diet is associated with a healthier diet and a greater likelihood of incorporating the necessary micronu-trients. The dietary diversity index (DDI) is the indicator that measures this variety, while the diet quality index (DQI) determines how much of this diversity consists of the inclusion of healthy foods. The aim of the study was to evaluate the quality and diversity of the diet of the Argentine population by identifying differences by sex, age, socioeconomic level, nutritional status and region. The sample consisted of 1266 subjects of urban population, of both sexes, between 15 and 65 years of age and of all socioeconomic levels. Anthropometric and intake assessment was performed, through 2 24-hour recalls. The DDI was assessed following the guidelines proposed in 2016 by Food and Agriculture Organization and the development of the DQI was performed following the methodology of Imamura y col. The DQI was relatively low, with a score of 63.9%. The DDI was 4.48 out of a maximum of 10, reflecting a poorly varied diet; additionally, only 50% of the population reported a varied diet. These indicators are significantly lower in people with low SEL. The DDI and the percentage of people with a diverse diet was higher in people from the metropolitan area of Buenos Aires. This study showed that the quality of the diet in the Argentine population is low and with a limited consumption of the food groups that provide the most micronutrients.
Abstract: Dietary diversity plays a major role in the health status of children. However, evidence on
its crucial role on children’s health status remains inconclusive in sub-Saharan Africa (SSA). In this
study, we examined the association between dietary diversity and undernutrition among children
aged 6–23 months in SSA. We pooled data from the most recent Demographic and Health Surveys of
32 countries in SSA from 2010 to 2020. A sample of 48,968 mother-child pairs of children within the
ages of 6–23 months and mothers aged 15–49 years were included in this study. Multilevel logistic
regression analysis was carried out to examine the association between dietary diversity and stunting,
wasting, and underweight. The results were presented as crude odds ratios (cOR) and adjusted odds
ratios (aOR) with their 95% confidence intervals. Statistical significance was set at p < 0.05. The
overall prevalence of minimum dietary diversity was 25.1%, with South Africa recording the highest
prevalence (43.9%) and Burkina Faso recording the lowest prevalence (5.6%). The highest prevalence
of stunting was recorded by Burundi (51.8%) while the lowest prevalence was found in Ghana
(13.6%), with an overall regional prevalence of 28.6%. For wasting, prevalence from all countries
was found to be 9.4%. South Africa recorded the lowest prevalence of wasting (2.1%) while Niger
recorded the highest prevalence (27.3%). Lastly, the prevalence of underweight ranged from 5.3% in
South Africa to 41.8% in Niger, with an all-country prevalence of 16.4%. Children who had adequate
minimum dietary diversity had 12% less likelihood of being stunted (aOR = 0.88, 95% CI = 0.83, 0.94),
compared to those who had inadequate minimum dietary diversity. Having an adequate minimum
dietary diversity significantly lowered the risk of underweight among children by 17% (aOR = 0.83,
95% CI = 0.77, 0.91). Having an adequate minimum dietary diversity was associated with 13%
reduced odds of wasting among children (aOR = 0.87, 95% CI = 0.78, 0.97), compared to those who
had inadequate minimum dietary diversity. This study highlights the significant association between minimum dietary diversity and stunting, wasting, and underweight among 6–23 month-old children
in SSA. There is an urgent need for additional nutrition-specific interventions and strengthening
of existing interventions aimed at improving infant and young child feeding practices, including
complementary feeding practices among children aged 6–23 months in the 32 countries in SSA. Such
interventions should focus more on countries where the prevalence of adequate minimum dietary
diversity was low and undernutrition was high.
OBJECTIVE: To investigate the association of dietary pattern and mortality in international data. DESIGN: Cohort study with 20 years' follow up of mortality. SETTING: Five cohorts in Finland, the Netherlands, and Italy. SUBJECTS: Population based random sample of 3045 men aged 50-70 years in 1970. MAIN OUTCOME MEASURES: Food intake was estimated using a cross check dietary history. In this dietary survey method, the usual food consumption pattern in the 6-12 months is estimated. A healthy diet indicator was calculated for the dietary pattern, using the World Health Organisation's guidelines for the prevention of chronic diseases. Vital status was verified after 20 years of follow up, and death rates were calculated. RESULTS: Dietary intake varied greatly in 1970 between the three countries. In Finland and the Netherlands the intake of saturated fatty acids and cholesterol was high and the intake of alcohol was low; in Italy the opposite was observed. In total 1796 men (59%) died during 20 years of follow up. The healthy diet indicator was inversely associated with mortality (P for trend < 0.05). After adjustment for age, smoking, and alcohol consumption, the relative risk in the group with the healthiest diet indicator compared with the group with the least healthy was 0.87 (95% confidence interval 0.77 to 0.98). Estimated relative risks were essentially similar within each country. CONCLUSIONS: Dietary intake of men aged 50-70 is associated with a 20 year, all cause mortality in different cultures. The healthy diet indicator is useful in evaluating the relation of mortality to dietary patterns.
We develop an integrated framework for testing theories of consumption behavior by examining how agricultural households in
rural India respond to anticipated and unanticipated seasonal income fluctuations. Using information on village-level rainfall
surprises, we estimate idiosyncratic unanticipated income shocks by allowing weather risk to impact households differently
depending on observable characteristics. In applying our methodology to unique panel data on consumption, debt, and intrahousehold
gift exchanges, we address a number of shortcomings in previous tests of theories of consumption behavior. Yet, we find no
evidence against the hypothesis that households smooth idiosyncratic fluctuations in their income. Our approach also uncovers
several interesting features of rural credit and insurance markets.
The aim was to investigate whether dietary factors cluster in a favourable or unfavourable way and to characterise the groups identified by lifestyle and sociodemographic variables.
This cross sectional study was based on data of the 1987-1988 Dutch national food consumption survey (DNFCS), obtained from a panel by a stratified probability sample of the non-institutionalised Dutch population.
3781 adults (1802 males and 1979 females) of the DNFCS, aged 19 to 85 years, were studied.
To estimate dietary intake two day food records were used. Lifestyle factors were collected by structured questionnaire and sociodemographic variables were available from panel information. Cluster analysis was used to classify subjects into groups based on similarities in dietary variables. Subsequently, these groups were characterised by sociodemographic and lifestyle factors as well as by the consumption of food groups. Eight clusters were found. In comparison with the guidelines, the dietary quality in four clusters was poor. The cluster with the poorest dietary intake (high intake of fat, cholesterol, and alcohol; low intake of dietary fibre) showed on average a high consumption of animal products (except milk), fats and oils, snacks, and alcoholic beverages, and a low consumption of fruit, potatoes, vegetables, and sugar rich products. Smoking, body mass index, dietary regimen on own initiative, hours of sleep, gender, age, socioeconomic status, and day of the week were found to discriminate among the clusters.
Cluster analysis resulted in substantial differences in mean nutrient intake and seems useful for dietary risk group identification. Undesirable lifestyle habits were interrelated in some clusters, but an exclusive lifestyle for health risk has not been found.
Data were analyzed from a cross-sectional nutrition surveillance survey to determine the association between extended breast-feeding and growth. The sample consisted of 2148 initially breast-fed children between 12 and 47 mo of age. Breast-feeding for > 24 mo was associated with a greater height-for-age Z score, and breast-feeding for > 18 mo was associated with greater weight-for-age and weight-for-height Z scores. These results remained significant after the number of food groups being consumed at 12 mo of age, age when the selected food items were first given to a child, the consumption of powered milk, recent infections, age, sex, birth order, birth weight, county of residence, father's occupation, and mother's education were controlled for. These results suggest that extended breast-feeding in this population, in which food was introduced late in infancy, was associated with improved nutritional status as measured by standard anthropometric indicators.
Data for 5,484 adults (aged 21 years and older) who participated in the 1987-88 Nationwide Food Consumption Survey (NFCS) were used to develop an index of overall dietary intake that related to the major, diet-related, chronic diseases in the United States. The low response rate of the 1987-88 NFCS has raised concerns about potential bias, but this large data set is useful for methodologic studies and research that does not attempt to generalize the results to the US population.
Dietary recommendations from the 1989 National Academy of Sciences publication Diet and Health were stratified into three levels of intake for scoring. Individuals who met a dietary goal were given a score of zero. Those who did not meet a goal, but had a fair diet, were given one point, and those who had a poor diet were given two points. These points were summed across eight diet variables to score the index from zero (excellent diet) to 16 (poor diet).
Lower index scores were positively associated with high intakes of other important measures of diet quality (eg, fiber, vitamin C). We found that single nutrients (such as dietary fat) were not necessarily associated with other measures of diet quality.
We concluded that this index ranking of overall dietary patterns was reflective of total diet quality, though substantial misclassification can result from using single nutrients or foods as indicators of diet quality.
We examined the relation of dietary diversity to subsequent all-cause mortality by using data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, 1982-1987. The analytic cohort consisted of 4160 men and 6264 women (including 2556 deaths), 25-74 y at baseline (1971-1975). Twenty-four-hour dietary recalls were evaluated for variety among the five major food groups: dairy, meat, grain, fruit, and vegetable, with a dietary diversity score (DDS); consumption of each food group contributed 1 point to a maximum possible DDS of 5. Age-adjusted risk of mortality was inversely related to DDS (P < or = 0.0009) in men and women. The inverse diversity-mortality association was adjusted for potential confounders: education, race, smoking status, and dietary fiber intake; the relative risk of mortality in men and women consuming two or fewer food groups was 1.5 (95% CI 1.2-1.8) and 1.4 (95% CI 1.1-1.9), respectively. In conclusion, diets that omitted several food groups were associated with an increased risk of mortality.
Although breast-feeding is widely accepted as important for infant health, its benefits during the second year of life have been questioned. We analyzed data from 107 breast-fed and weaned Peruvian children living in a periurban community to determine whether breast milk contributed to improved linear growth between 12 and 15 mo of age. Breast-feeding frequency was self-reported; intakes of complementary foods and animal products were estimated from a food-frequency survey. Multivariate-linear-regression analysis was used to predict the length of the children at 15 mo of age. Determinants of length included length and weight-for-length at 12 mo of age (US National Center for Health Statistics standards), interval between 12- and 15-mo measurements, breast-feeding frequency, incidence of diarrhea, and intakes of complementary and animal-product foods. Complementary foods, animal-product foods, and breast milk all promoted toddlers' linear growth. In subjects with low intakes of animal-product foods, breast-feeding was positively associated (P < 0.05) with linear growth. There was a 0.5-cm/3 mo difference in linear growth between weaned toddlers and children who consumed the average number of feedings of breast milk. Linear growth was also positively associated with intake of animal-product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in subjects with high complementary-food intakes. When the family's diet is low in quality, breast milk is an especially important source of energy, protein, and accompanying micronutrients in young children. Thus, continued breast-feeding after 1 y of age, in conjunction with feeding of complementary foods, should be encouraged in toddlers living in poor circumstances.
Prolonged breastfeeding in developing countries is routinely recommended as a valuable and cost-effective public health measure to promote early childhood growth. However, the effects of breastfeeding beyond 12 months are unclear, with some studies showing positive, and some showing negative effects. The role of complementary foods for children 1-3 years has been less studied.
We examined feeding behaviour and illness data in relation to anthropometric status among 154 rural western Kenyan children, aged 12-36 months.
There was little difference in anthropometric status between partially breastfed and fully weaned children. Rather, dietary diversity (number of different foods consumed) was strongly and consistently related to anthropometric status in this age group. In addition, early complementation with starchy gruels was associated with stunting.
Public health efforts which focus only on prolonged breastfeeding (>12 months) in developing countries will not ensure adequate early childhood growth. Important complementary feeding recommendations that promote diet diversity, through the inclusion of a variety of foods in the diets of children in the 1-3 year age group, are needed.
This study assesses whether a simple count of food items and food groups can predict the nutritional adequacy of the diet in an economically poor country.
A three-day weighed record of children.
Koutiala town, in Southeastern Mali.
Seventy-seven children, 13-58 months of age. One child was excluded owing to an extraordinarily low food variety.
The study was conducted in April August 1995. Data from this study were used to create two different indices: Food Variety Score (FVS), a simple count of food items, and Dietary Diversity Score (DDS), a count of food groups. Mean Adequacy Ratio (MAR) was calculated as an indicator for nutrient adequacy, and used to validate FVS and DDS.
Mean (s.d.) FVS was 20.5 (3.8) and mean (s.d.) DDS was 5.8 (1.1). A positive correlation was found both between FVS and MAR (Pearson 0.33, P < 0.001) and DDS and MAR (Pearson 0.39, P < 0.001). With cut-off points for FVS at 23 and for DDS at 6, the indices have high ability to identify those with a nutritionally inadequate diet. MAR increased with increasing FVS and DDS. FVS needs to be at least 15 or DDS at least 5 to give a satisfactory MAR.
Although a simple count of food items or food groups cannot give a full picture of the adequacy of the nutrient intake, the results from this study show that the food scores can give a fairly good assessment of the nutritional adequacy of the diet, particularly if combined. Such indicators are important for identification of vulnerable groups in areas where people normally eat from a shared bowl, which makes detailed dietary intake studies difficult, time consuming and expensive.
Childhood malnutrition is widespread in the Sahel region of Africa. In Niger, the 1992 Population and Health Survey found that 32% of children under the age of five years had stunted growth and 16% had muscle wasting. Vitamin A deficiency and anemia are major health problems and it is thought that the rate of zinc deficiency is also high. However, very little is known about the dietary intakes of children. The aim of this study was to assess food consumption, energy and nutrient intake in weaned, preschool age children and to assess their risks of deficiency. Three surveys were conducted in periods of food shortage. Two of the surveys were carried out one year apart, in the rainy season (August to September). The third was conducted at the end of the subsequent dry season (July). Sixty children from rural areas (30 girls and 30 boys) aged 2 to 4 years of age at the start of the study (mean age 36.8 + 7.0 months) from the Ouallam district (western Niger) were studied in surveys 1 and 2, and thirty of these children were then studied in the third survey. Food intake was assessed using a modified weighed intake technique. All foods and beverages consumed by the child at each meal were recorded over three days. The raw ingredients of homemade family meals were weighed and the final cooked weight was also recorded. If the child ate from a shared bowl, the number of mouthfuls was counted and three mouthful samples were weighed. Total serving size was then calculated based on the number of mouthfuls and the mean mouthful weight. Snacks and meals eaten away from home were assessed by questioning the mother. Energy, protein, vitamin A, iron and zinc intakes were compared using the most relevant food composition data and the adequacy of the diet was determined from international recommendations for intake. Energy, iron and zinc requirements were adjusted for diets with a low level of digestibility. Protein requirements were adjusted according to the protein mix quality score (67%). The frequency of inadequate intake was calculated using the probability approach of Beaton (1985) or cutoff values roughly corresponding to the mean requirements for particular age/sex groups. Two overall diet scores were used: a nutritional quality score (NQS) and a diversity score (DS). The relationships between dietary intakes and scores, children's weights and heights were investigated. As expected, the children included in the study had monotonous diets, with few animal products, fats, fruits and vegetables other than green leaves (Figure 1). Cereals made up 80 to 90% of total energy, protein, iron and zinc intake. Green leaves supplied most of the vitamin A intake. Intakes were chronically inadequate, particularly during the rainy season, with only vitamin A intake being adequate (Table 1). Almost all the children were at high risk of zinc deficiency. Diet quality and diversity scores were correlated (Tables 2 and 3). About half the children had stunted growth (Table 4). Energy, protein and zinc intakes were highly and significantly correlated with the anthropometric status of the child one year later, particularly with height-for-weight Z scores, and with dietary NQS (Table 5). Both dietary scores were positively correlated with weight and height indices. However, only NQS was significantly associated with weight-for-height index, higher NQS scores being associated with higher growth indices. Diet quality also predicted the anthropometric status of the child one year later. Our findings suggest that both dietary scores are relevant but that the diversity of food eaten may be a better determinant of growth status if energy intake is close to meeting dietary requirements. Multiple dietary inadequacies are frequent among children from developing countries so scores of overall dietary quality may be more appropriate indicators than the intakes of specific nutrients. (ABSTRACT TRUNCATED)
To evaluate a revision of the Diet Quality Index called the Diet Quality Index Revised (DQI-R).
The original Diet Quality Index was revised to reflect current dietary guidance, to incorporate improved methods of estimating food servings, and to develop and incorporate measures of dietary variety and moderation. The scoring of the original scale was reversed in direction and expanded to a 100-point scale to improve interpretability.
Data from the 1994 Continuing Survey of Food Intakes by Individuals were used. A sample of 3,202 adults aged 18 and older contributed 2 days of dietary intake data based on 24-hour recalls for the development and revision of various components of the DQI-R.
Pearson correlation analyses, ordinary least squares regression analyses, and a nonparametric test to determine trends across ordered groups were used.
The mean DQI-R score for the 1994 sample was 63.4 of a possible 100-point score. Sample respondents were more likely to have met dietary guidance in the areas of dietary cholesterol (66.9% met goal) and iron intakes (59.6% met goal) relative to the Recommended Dietary Allowances but less likely to have met goals related to fruit servings (19.6% met goal), grain servings (23.1% met goal), and calcium intakes (16.6% met goal) relative to the Recommended Dietary Allowance. There is a statistically significant quantitative and qualitative improvement in all components of the DQI-R as one moves from the lowest grouping of scores to the highest. For example, persons with DQI-R scores less than 40 consumed 43.9% of energy from fat, 72% of the Adequate Intake for calcium, and 6.7% of the recommended servings of fruit per day. In contrast, those with DQI-R scores greater than 80 consumed 24.2% of energy from fat, 101% of the Adequate Intake for calcium, and 137% of the recommended servings of fruit per day.
The DQI-R reflects the dietary guidance principles of macronutrient distribution, moderation, variety, and proportionality. Although the index was designed to monitor dietary changes in populations rather than individuals, each index component reflects an aspect of national dietary guidance. Calculation of DQI-R scores for an individual should provide an estimate of diet quality relative to national guidelines, and differences in scores over time should suggest improvement or decline in overall diet quality.
The purpose of this study was to analyse the associations between the food variety score (FVS), dietary diversity score (DDS) and nutritional status of children, and to assess the associations between FVS, DDS and socioeconomic status (SES) on a household level. The study also assessed urban and rural differences in FVS and DDS.
Cross-sectional studies in 1994/95, including a simplified food frequency questionnaire on food items used in the household the previous day. A socioeconomic score was generated, based on possessions in the households. Weight and height were measured for all children aged 6-59 months in the households, and anthropometric indices were generated.
Three hundred and twenty-nine urban and 488 rural households with 526 urban and 1789 rural children aged 6-59 months in Koutiala County, Sikasso Region, Mali.
Children from urban households with a low FVS or DDS had a doubled risk (OR>2) for being stunted and underweight. Those relations were not found in the rural area. There was an association between SES and both FVS and DDS on the household level in both areas. The FVS and DDS in urban households with the lowest SES were higher than the FVS and DDS among the rural households with the highest SES.
Food variety and dietary diversity seem to be associated with nutritional status (weight/age and height/age) of children in heterogeneous communities, as our data from urban areas showed. In rural areas, however, this association could not be shown. Socioeconomic factors seem to be important determinants for FVS and DDS both in urban and rural areas. FVS and DDS are useful variables in assessing the nutritional situation of households, particular in urban areas.
This paper describes the development and efficacy of a diet quality index (DQI) for China.
The Dietary Guidelines for Chinese Residents motivated the selection of 10 DQI components. These components were weighted and assigned cut-offs and point schemes based on the Chinese Food Guide Pagoda, Chinese and/or international dietary reference values. The efficacy of resulting DQI scores was assessed relative to a priori expectations.
The Chinese DQI was evaluated using cross-sectional 3 day diet record and anthropometric data on 7450 adults from the 1991 China Health and Nutrition Survey.
For each individual, a DQI total score was calculated as the sum of components, and DQI pattern scores calculated to reflect the underlying composition of diet quality problems. The DQI scores were compared with component scores, food and nutrient intake, weight status and sociodemographic variables.
The total DQI score simultaneously represented all component aspects of diet quality as well as micronutrients not explicitly built into the index. The total DQI score was significantly correlated with food and nutrient intakes, BMI, urban residence and income. The DQI pattern scores correlated with DQI components and weight status as expected.
The China DQI captures variation along several components of diet quality, appears sensitive to under- and overnutrition, as well as sociodemographic variables. The China DQI may prove useful for monitoring the nutrition transition and epidemiologic trends in China.
National Institutes of Health (HD 38700 and R01-HD30880) and the Chinese Academy of Preventive Medicine.
Objective:
To evaluate dietary quality of European and American elderly subjects using different derivatives of dietary patterns (dietary scores and clusters) and to investigate the relationship of these approaches to nutritional and lifestyle factors.
Design:
Data from the cross-sectional SENECA baseline study and Framingham Heart Study (original cohort and offspring) were used for data analysis. Food intake data were summarised into dietary clusters and into dietary scores (Healthy Diet Indicator and Mediterranean Diet Score). These measures of dietary quality were then tested for associations with lifestyle factors and measures of nutritional status.
Subjects/setting:
The study population, aged 70-77 y, consisted of 828 subjects from Framingham, MA (USA) and 1282 subjects from the following European centres: Hamme, Belgium; Roskilde, Denmark; Padua, Italy; Culemborg, The Netherlands; Vila Franca de Xira, Portugal; Betanzos, Spain; and Yverdon, Burgdorf and Bellinzona, Switzerland.
Results:
Dietary intake varied widely across the European and American research centres. In general, Southern European centres and Framingham had higher mean diet scores, indicating a higher dietary quality, than Northern European centres (MD-scores: 4.2-4.4 vs 2.7-3.5). Cluster analysis identified the following five dietary patterns characterised by: (1) sugar and sugar products; (2) fish and grain; (3) meat, eggs and fat; (4) milk and fruit; and (5) alcohol intake. The meat, eggs and fat pattern had significantly lower average dietary quality, as measured with all three diet scores than all other groups except the alcohol group. The fish and grain group had significantly better Mediterranean diet scores than all other groups.
Conclusions:
Dietary scores and dietary clusters are complementary measures to classify dietary quality. The associations with nutritional and lifestyle factors indicate the adequate categorisation into dietary quality groups.
Sponsorship:
European Union, US Department of Agriculture, Agriculture Research Service, under agreement (58-1950-9-001), Haak Bastiaanse-Kuneman Foundation.
The Nutrition Section of the Mozambican Ministry of Health recently implemented a low-cost, rapid field tool for assessing the quality of household diets. Such tools can play an important part in targeting development assistance in countries where resources are scarce. This paper evaluates how well the tool performs at describing household dietary intakes in northern Mozambique and explores ways to improve it. The food-group classification and scoring system that form the core of the tool were applied to household data (n = 1,140) collected in a previous quantitative diet study in Nampula and Cabo Delgado Provinces. Using mean intakes as a criterion, the diet assessment tool performed well on all nutrients studied, except vitamin A. Those classified by the tool into the top group of diet quality had the highest mean intakes of energy, protein, and iron as well as the highest mean scores on the Mozambican Diet Quality Index, whereas those classified in the bottom group had the lowest intakes. Sensitivity rates for the diet assessment tool could be substantially improved by raising the cutoff point for an acceptable diet from the current threshold of 20 points to 23 points. Regression analysis was used to suggest other possible improvements. Such improvements were only marginal and do not justify field implementation, given the added complexity in classifying and scoring. This paper provides evidence that, with some minor changes, the Ministry of Health diet assessment method can be a useful tool in describing the dietary situation of groups of Mozambican households. Since this tool is both inexpensive and simple to use, there may be interest in adapting it for use in other low-income countries. A series of steps for doing so is outlined at the end of this paper.
Household food security is an important measure of well-being. Although it may not encapsulate all dimensions of poverty, the inability of households to obtain access to enough food for an active, healthy life is surely an important component of their poverty. Accordingly, devising an appropriate measure of food security outcomes is useful in order to identify the food insecure, assess the severity of their food shortfall, characterize the nature of their insecurity (for example, seasonal versus chronic), predict who is most at risk of future hunger, monitor changes in circumstances, and assess the impact of interventions. However, obtaining detailed data on food security status—such as 24- hour recall data on caloric intakes—can be time consuming and expensive and require a high level of technical skill both in data collection and analysis. This paper examines whether an alternative indicator, dietary diversity, defined as the number of unique foods consumed over a given period of time, provides information on household food security. It draws on data from 10 countries (India, the Philippines, Mozambique, Mexico, Bangladesh, Egypt, Mali, Malawi, Ghana, and Kenya) that encompass both poor and middle-income countries, rural and urban sectors, data collected in different seasons, and data on calories acquisition obtained using two different methods. ....[D]ietary diversity would appear to show promise as a means of measuring food security and monitoring changes and impact, particularly when resources available for such measurement are scarce.
The average annual intake of specific nturients, foods, food groups, and proxies for nutrient bioavailability of 87 Mexican preschoolers and 110 schoolchildren were compared with their anthropometry. Children consuming a lower proportion of tortillas and legumes and more animal products were taller and heavier. Even though the high-tortilla dietary pattern provided more of most nutrients, these were less available. In conclusion, children's size was predicted by dietary quality - not quantity - measured either as a high intake of animal products or as a lower intake of factors inhibiting nutrient bioavailability. -from Authors
The herders of the cooperative reported less illness and work disruption than members of the town or community. The diversity of their diet has increased, and their children appear to be better nourished. They live in the only site to clearly benefit from the agrarian reform. The households in the agrarian community, which reported the most illness and work disruption, and whose children showed the greatest degree of undernutrition, neither gained nor lost land in the reform. People from the town showed the greatest increase in dietary diversity among the three locales, but fell between the two rural sites in levels of illness and nutritional status. Substantial variation in diet, nutrition and health status was present in the town and reflected the increased socioeconomic variation which had occurred in the town over the past 15 yr. -from Author
Food intakes of rural Malawian (29F. 36M; 62 ± 10 mo) and Ghanaian (83F, 65M; 59 ± 10 mo) children were estimated at two seasons using 3‐day weighed records. Food patterns, dietary diversity, based on the number, and frequency of foods consumed, and major sources of energy and selected nutrients were examined. The total, and average number of food items consumed per day were lower in Malawi (62, 6.4 ± 1.4 per day) than in Ghana (70 ‐ 76. 7.5 ± 1.3 ‐ 8.0 ± 1.2 per day). More Malawian than Ghanaian children (25 and 46% versus 12 and 27%, depending on season) consumed 6 food items or less per day. Major energy sources were cereals (51–69%) in Malawi, and cereals (24–41%), and roots (24–37%) in Ghana; animal products contributed 3–7% of the energy. Dietary diversity was associated with intakes of energy (per kg BW) (r = 0.33–0.41; p < 0.02) in Malawi, the consumption of prestigious foods and snacks in both countries, and with purchased meals in Ghana. Hence, increased consumption of nutrient dense purchased meals and snacks could increase the diversity and energy content of some rural African diets.
Although debate on breast cancer and diet has been concentrated on nutrients, assessment of the role of specific foods and food groups and variety of food intake retains a considerable importance. To further elucidate the role of dietary habits, 2,569 women with incident breast cancer (median age 55 years) and 2,588 control women (median age 56 years), hospitalised with acute non-neoplastic diseases, were interviewed between 1991 and 1994 in 6 different Italian areas. The validated food frequency questionnaire included 79 food items and recipes, which were grouped into 18 food groups (5 for “diversity” analyses purpose). After allowance for non-dietary confounding factors and total energy intake, significant trends of increasing breast cancer risk with increasing intake emerged for the following food groups: bread and cereal dishes, pork and processed meats, and sugar and candies. Conversely, high intake of milk, poultry, fish, raw vegetables, potatoes and coffee and tea seemed to exert a protection against the development of breast cancer. Intake of soups, eggs, other meats, cheese, cooked vegetables, citrus fruits, other fruits and cake and desserts were not significantly related to breast cancer risk. The variety of vegetable types consumed weekly seemed to have a beneficial effect beyond the advantage of high vegetable intake per se. © 1995 Wiley-Liss, Inc.
Most studies examining the dynamics of welfare have found large fluctuations in consumption over relatively short periods, suggesting substantial short-run movements in and out of poverty. The consequence is that cross-section poverty research may not be able to identify the poor. In this study, we explore this short-run variability further. We use a data set on a panel of 1450 households in different communities in rural Ethiopia, surveyed thrice, over 18 months. On average year-to-year poverty is very similar. However, we find high variability in consumption and poverty, over the seasons and year-by-year. Econometric analysis suggests that consumption is affected by idiosyncratic and common shocks, including rainfall and household-specific crop failure, while households respond to seasonal incentives related to changing labour demand and prices. The results imply that a larger number of households are vulnerable to shocks than implied by the standard poverty statistics, while some of the non-poor in these statistics are in fact otherwise poor households temporally boosting their consumption as an optimal response to changing seasonal incentives.
The authors investigate nutrition and expenditure in rural Maharashtra in India. They estimate that the elasticity of calorie consumption with respect to total expenditure is 0.3-0.5, a range that is in accord with conventional wisdom. The elasticity declines only slowly with levels of living and is far from the value of zero suggested by a recent revisionist literature. In these Indian data, the calories necessary for a day's activity cost less than 5 percent of the daily wage, which makes it implausible that income is constrained by nutrition rather than the other way around. Copyright 1996 by University of Chicago Press.
The extent of diversity in the diets of black and white adults (n = 11,658) aged 19 to 74 years was evaluated from 24-hour dietary recalls obtained in the second National Health and Nutrition Examination Survey. Each 24-hour recall was evaluated for the consumption of items from the dairy, meat, grain, fruit, and vegetable groups (Food Group Score). A second scoring method (Serving Score) evaluated every recall for consumption of at least two servings each from dairy, meat, fruit, and vegetable groups and four servings from the grain group. Only a third of the population surveyed reported consuming foods from all the food groups on the survey day; less than 3% reported consuming foods from all food groups in at least the recommended amount. Blacks scored lower on both types of diet diversity scores than whites. Both types of diversity scores showed a significant trend to increase with increasing income and level of education. Failure to consume any foods from the dairy, meat, grain, fruit, and vegetable groups was reported by 24%, 6%, 5%, 46%, and 18%, respectively, of the population on the survey day. The proportion of the population consuming at least the desired number of servings from each of these food groups was 51%, 71%, 29%, 29%, 61%, respectively. The results emphasize the need for major public campaigns directed at increasing the diversity of US diets. Special target groups include minorities and those with limited income and formal education.
The purpose of this study was to examine the effects of overall dietary variety, variety among major food groups, and variety within major food groups on dietary quality. Nutritional adequacy, one aspect of dietary quality, was measured by a Mean Adequacy Ratio (MAR)--an index of the percent of recommended intake for 11 nutrients. Other dietary quality measures included the percent of calories from fat and sugar and total intakes of energy, cholesterol, and sodium. A study sample of 3,701 individuals was selected from USDA's 1977-78 Nationwide Food Consumption Survey, excluding pregnant and lactating women and children under 1 year of age. Multiple regression analyses were performed to examine the relationships between each type of variety and each diet quality measure, controlling for age, sex, the number of foods, and all of their two-way interactions with variety. The variety terms added a significant increment to the variation in MAR that was explained by each of the models. Variety among five major food groups explained as much of the variation in MAR as did variety within those groups. Thus, dietary variety might best be defined as simply including foods from each of the major groups. Increases in this type of variety were associated with greater increases in MARs for females than for males and for persons with lower vs. higher numbers of foods. None of the types of variety could account for a sizeable proportion of the variation in the intakes of energy, fat, sugar, sodium, or cholesterol. That is, those measures were not related in any appreciable way to variety per se--either to the expansion or to the restriction of food choices. The key to limiting the intake of those constituents may be to selectively alter the scope of food choices to include more of some foods and less of others.
The performance of an indicator of health or nutritional status depends on its sensitivity and specificity properties over a range of cut-offs. Frequently, it is of interest to compare indicators to pick the best for a given purpose, such as screening for disease or monitoring to detect changes in prevalence of inadequate nutriture. Relative operating characteristic (ROC) analysis provides an objective method for making this comparison, but the application of this methodology as described for epidemiologists in this Journal is now outdated for most indicators. Recent developments are noted and an alternative analysis for use with continuous Gaussian data is presented here. The estimators and statistical test procedures proposed here are compared with the previously described methods, by means of a computer simulation study. The new procedures are found to be superior for continuous Gaussian data, and have the practical advantage that they do not require use of a specialized computer program. The implications of these results for comparing indicators to be used to monitor population prevalences are discussed.
An evaluation of 212 24-hour dietary intakes showed than an assessment using a nutrient adequacy score and comparing actual nutrient intakes to Recommended Dietary Allowances was similar to an assessment with a dietary score based on food groupings. This suggests that the simple dietary score can be substituted for the more complete and time-consuming dietary analysis when program effectiveness is evaluated.
To develop an index of overall diet quality.
The Healthy Eating Index (HEI) was developed based on a 10-component system of five food groups, four nutrients, and a measure of variety in food intake. Each of the 10 components has a score ranging from 0 to 10, so the total possible index score is 100.
Data from the 1989 and 1990 Continuing Survey of Food Intake by Individuals were used to analyze the HEI for a representative sample of the US population.
Frequencies, correlation coefficients, means.
The mean HEI was 63.9; most people scored neither very high nor very low. No one component of the index dominated the HEI score. People were most likely to do poorly in the fruit, saturated fat, grains, vegetable, and total fat categories. The HEI correlated positively and significantly with most nutrients; as the total HEI increased, intake for a range of nutrients also increased.
The HEI is a useful index of overall diet quality of the consumer. The US Department of Agriculture will use the HEI to monitor changes in dietary intake over time and as the basis of nutrition promotion activities for the population.
Scientists have long recognized the importance of the demographics and epidemiologic transitions in higher income countries. Only recently has it become understood that similar sets of broadly based changes are occurring in lower income countries. What has not been recognized is that concurrent changes in nutrition are also occurring, with equally important implications for resource allocation in many low-income countries. Several major changes seem to be emerging, leading to a marked shift in the structure of diet and the distribution of body composition in many regions of the world: a rapid reduction in fertility and aging of the population, rapid urbanization, the epidemiologic transition, and economic changes affecting populations in different and uneven ways. These changes vary significantly over time. In general, we find that problems of under- and overnutrition often coexist, reflecting the trend in which an increasing proportion of people consume the types of diets associated with a number of chronic diseases. This is occurring more rapidly than previously seen in higher income countries, or even in Japan and Korea. Examples from Thailand, China, and Brazil provide evidence of the changes and trends in dietary intake, physical activity, and body composition patterns.
To evaluate the usefulness of the Food Guide Pyramid as a quantitative tool for assessing nutritional adequacy and quality.
One-day food records (n = 2,489) were assigned food group scores (1 through 5) by two systems. System 1 recorded the number of food groups on a given record that included the minimum number of servings suggested by the Food Guide Pyramid. System 2 recorded the number of food groups in the Food Guide Pyramid for which at least one serving was included. The food records were further evaluated by mean adequacy ratio (MAR) for iron, calcium, magnesium, vitamin A, and vitamin B-6 (MAR-5 score) and percentage of energy contributed by fat and sugar. Sensitivity and specificity of the food group scores to predict nutritional inadequacy were determined.
College students (n = 2,489) attending introductory nutrition, foods, and health-related courses at a mid-western university.
Student's t test, chi2 test, Dunnett's multiple mean comparison test.
A food group score of 5 was given to 11% and 35% of the diet records by systems 1 and 2, respectively; MAR-5 scores of 75 or greater were given to 70% of the records. Only 4% of the diets contained both 30% or less and 10% or less of energy from fat and sugar, respectively. Both scoring systems can be used as a quantitative tool for screening nutritional inadequacy with high sensitivity (correctly classifying nutritionally inadequate diets) but with a moderate to low specificity (correctly classifying nutritionally adequate diets).
This article reviews the published indexes of overall diet quality. Approaches used for measuring overall diet quality include those based on examination of the intake of nutrients, food groups, or a combination of both. A majority of the indexes have been examined in relation to nutrient adequacy only; few have been evaluated for assessment of quality according to current dietary guidelines, namely, a diet relatively low in fat that meets energy and nutrient needs. The indexes of overall diet quality were related to the risk of disease more strongly than individual nutrients or foods.
To develop a new dietary variety score (DVS) and link it to other measures of diet quality, including a modified diet quality index (DQI).
The subjects were 24 healthy young (ages 20 to 30 years) and 24 healthy older (ages 60 to 75 years) adults, including 24 men and 24 women. Their dietary intake assessments were based on one 24-hour food recall interview and 14 consecutive days of food records.
Energy and nutrient intakes were estimated using Nutritionist IV software. DVS was based on the cumulative number of different foods consumed over the 15-day period. DQI was a 5-point scale based on conformity with the key US dietary recommendations. Full score was awarded for diets deriving 30% or less of energy from fat, 10% or less of energy from saturated fat, more than 50% of energy from carbohydrate, and containing less than 300 mg cholesterol and 2,400 mg sodium per day. Analytic measures included analyses of variance, correlation analyses, and chi 2 tests.
Older subjects consumed more varied diets than did young subjects. Higher DVS values were linked positively to vitamin C intakes and negatively to the consumption of salt, sugar, and saturated fat. However, a high DVS was not linked to a high score on the DQI in this subject sample.
Few studies have addressed the issue of how many different foods constitute a varied diet. The present classification scheme offers a new way of assessing dietary variety at the individual or group level. Measures of dietary variety may represent an additional facet of diet quality and their relationship to selected health outcomes should be examined further.
Recently, the concept of food-based dietary guidelines has been introduced by WHO and FAO. For this concept, several assumptions were necessary. The validity and potential consequences of some of these assumptions are discussed in this paper on the basis of the Dutch National Food Consumption Surveys. The topics were interrelationships among dietary characteristics, nutrient density, diets in accordance with the guidelines, and food variety.
To obtain insight into overall diet quality, a dietary quality index based on nutrients and a food-based quality index based on food groups were created and tested. As expected the results showed that a higher dietary quality index was associated with an improved intake of the nutrients included in the index, in particular a lower intake of total fat and cholesterol. This was related to a lower consumption of cheese, fats and oils, meat and meat products, and a higher consumption of fruit and vegetables. The information obtained with a dietary quality index can be used to assess the feasibility of a particular goal in combination with other relevant goals and to obtain clues or confirmation for recommendations regarding food consumption.
The food-based quality index created showed that a combination of several food-based goals (formulated in quantitative terms) was associated with an increase in food consumption, without a clear relevance for the dietary quality. Therefore, the formulation of food-based guidelines should be based on explicitly stated dietary goals. The findings regarding nutrient density were in the direction of what was assumed, namely a positive association between density and absolute intake, although the expected effects were not completely found. The results regarding the association between variety and dietary intake were characterized mainly by differences in quantity rather than dietary quality.
The data indicate that energy intake may be an important pitfall in implementing food-based dietary guidelines, that ‘eat a variety of food’ can be an empty slogan and that nutrient density is positively related to the absolute intake of specific micronutrients. Further, the ‘absence’ of interrelationships among risk nutrients indicates that a selection process has to be applied.
Data from the Demographic and Health Surveys (DHS) for 5 Latin American countries (7 data sets) were used to explore the feasibility of creating a composite feeding index and to examine the association between feeding practices and child height-for-age Z-scores (HAZ). The variables used for the index were as follows: current breast-feeding, use of complementary foods and liquids in the past 24 h, frequency of use over the past week and feeding frequency. The index was made age specific for 6- to 9-, 9- to 12- and 12- to 36-mo-old age groups, and age-specific feeding terciles were created. Bivariate analyses showed that feeding practices were strongly and significantly associated with child HAZ in all 7 data sets, especially after 12 mo of age. Differences in HAZ between child feeding terciles remained significant after controlling for potentially confounding influences, for all countries except Bolivia. Multiple regression analyses also revealed that better feeding practices were more important for children of lower, compared with higher socioeconomic status (in Colombia 1995 and Nicaragua 1998); among children of Ladino (Spanish speaking) compared with indigenous origin (in Guatemala 1995); and among children whose mothers had primary schooling compared with mothers with no schooling, or mothers with higher than primary school level (Peru 1996). The data available in DHS data sets can thus be used effectively to create a composite child feeding index and to identify vulnerable groups that could be targeted by nutrition education and behavior change interventions.
This paper provides an empirical analysis of the causes of short-run food insecurity. It begins with a preliminary investigation of the correlations between two “external” factors (values of food imports, real merchandise exports) and two “internal” ones (real per capita income, domestic food production) with instability in food consumption. Then it attempts to elaborate the variables which are systematically associated with fluctuations in food consumption by applying a regression method, both simple and multiple, on a cross-section basis. As a measure of food consumption instability, an index based on the consumption theory is used. The analysis indicates that although both “external” and “internal” factors have a significant bearing on food consumption instability, instability in domestic food production is the most important single factor.
Cross-section estimates of income elasticities for food staples in the aggregate based on quantity information from household food expenditure surveys are often in the 0.3–0.6 range. It is shown that differences in per capita calorie intakes across income groups implied by these income elasticities are grossly inconsistent with observed differences in bodyweights. Moreover, time series data frequently indicate that national per capita consumption of food staples in the aggregate remains constant even as per capita gross national product rises substantially. Cross-section income elasticity estimates are biased upwards due to the failure of food expenditure surveys to undertake an accurate accounting of food transfers from high to low income groups, biases which are not generated by survey techniques which record food intakes directly.
The recommended dietary allowance of nutrients and the Chinese dietary guidelines
- Chinese Nutrition
Chinese Nutrition Society. 1990. The recommended dietary allowance of nutrients and the Chinese dietary guidelines. Acta Nutr Sini 12: 1-5
Measuring dietary diversity: A guide
- J Hoddinott
Hoddinott, J. Measuring dietary diversity: A guide. 2002. Washington, D.C.: Food and
Nutrition Technical Assistance, Academy for Educational Development.
Summary indicators for infant and child feeding practices: An example from the Ethiopia Demographic and Health Survey 2000. Food Consumption and Nutrition Division Discussion Paper
- M Arimond
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