Dietary Variation among Children Meeting and Not Meeting Minimum Dietary Diversity: An Empirical Investigation of Food Group Consumption Patterns among 73,036 Children in India

ABSTRACT Background Minimum Dietary Diversity (MDD) is a widely used indicator of adequate dietary micronutrient density for children 6–23 mo old. MDD food-group data remain underutilized, despite their potential for further informing nutrition programs and policies. Objectives We aimed to describe the diets of children meeting MDD and not meeting MDD in India using food group data, nationally and subnationally. Methods Food group data for children 6–23 mo old (n = 73,036) from the 2015–16 National Family Health Survey in India were analyzed. Per WHO standards, children consuming ≥5 of the following food groups in the past day or night met MDD: breast milk; grains, roots, or tubers; legumes or nuts; dairy; flesh foods; eggs; vitamin A–rich fruits and vegetables; and other fruits and vegetables. Children not meeting MDD consumed <5 food groups. We analyzed the number and types of foods consumed by children meeting MDD and not meeting MDD at the national and subnational geographic levels. Results Nationally, children not meeting MDD most often consumed breast milk (84.5%), grains, roots, and tubers (62.0%), and/or dairy (42.9%). Children meeting MDD most often consumed grains, roots, and tubers (97.6%), vitamin A–rich fruits and vegetables (93.8%), breast milk (84.1%), dairy (82.1%), other fruits and vegetables (79.5%), and/or eggs (56.5%). For children not meeting MDD, district-level dairy consumption varied the most (6.4%–79.9%), whereas flesh foods consumption varied the least (0.0%–43.8%). For children meeting MDD, district-level egg consumption varied the most (0.0%–100.0%), whereas grains, roots, and tubers consumption varied the least (66.8%–100.0%). Conclusions Children not meeting MDD had low fruit, vegetable, and protein-rich food consumption. Many children meeting MDD also had low protein-rich food consumption. Examining the number and types of foods consumed highlights priorities for children experiencing the greatest dietary deprivation, providing valuable complementary information to MDD.

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The Influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania

10.21203/rs.2.16657/v1 ◽

2019 ◽

Author(s):

Ahmed Gharib Khamis ◽

Akwilina Wendelin Mwanri ◽

Julius Edward Ntwenya ◽

Katharina Kreppel

Keyword(s):

Fruits And Vegetables ◽

Dietary Diversity ◽

Secondary Data ◽

Food Group ◽

Limited Information ◽

Food Groups ◽

Child Feeding ◽

Young Child Feeding ◽

Nutritional Status Of Children ◽

Minimum Dietary Diversity

Abstract Background Undernutrition poses a serious health challenge in developing countries. Tanzania has the highest undernutrition burdens in East and Southern Africa. Poor infant and young child feeding practices including consumption of undiversified diet are the main cause for undernutrition. There is limited information regarding the association between dietary diversity and undernutrition in Tanzania. The objective of this paper was to examine to what extent the dietary diversity is associated with undernutrition of children of 6 to 23 months in Tanzania.Methods This is a secondary data analysis from data collected by the Tanzania Demographic and Health Survey of 2015-2016. Stunting, wasting and underweight were calculated from Z-scores based on 2006 WHO standards. A dietary diversity score was created by summing the number of food groups reported for each child by the mother ranging from 0 to 7. Then, a Minimum Dietary Diversity (MDD) indicator was used to assess the diversity of the diet given to children. Bivariate and multivariate logistic regression techniques were used to assess the odds ratios of becoming undernourished.Results A total of 2,960 children were enrolled in this study. The majority (73.9%) of children did not reach the recommended Minimum Dietary Diversity (MDD). The most commonly consumed types of foods were grains, roots and tubers (91%), and Vitamin A containing fruits and vegetables (65%). Consumption of a diverse diet was significantly associated with a reduction of stunting, wasting and being underweight in children. The likelihood of being stunted, wasted and underweight was found to decrease as the number of food group consumed increased. Children who did not received an MDD diet had a significantly higher likelihood of being stunted (AOR=1.37, 95% CI; 1.13-1.65) and underweight (AOR=1.49, 95% CI; 1.15-1.92), but this was not the case for wasting. Consumption of animal source foods has been found to be associated with reduced stunting among children.Conclusion Consumption of a diverse diet was associated with a reduction in undernutrition among children of 6 to 23 months in Tanzania. Measures to improve the type of complementary foods in order to meet the energy and nutritional demands of children should be considered in Tanzania.

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What empowerment indicators are important for food consumption for women? Evidence from 5 sub-Sahara African countries

PLoS ONE ◽

10.1371/journal.pone.0250014 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250014

Author(s):

Michael Nnachebe Onah ◽

Sue Horton ◽

John Hoddinott

Keyword(s):

Vitamin A ◽

Food Consumption ◽

Fruits And Vegetables ◽

Dietary Diversity ◽

Women's Empowerment ◽

Women’S Empowerment ◽

Food Groups ◽

African Countries ◽

Logistic Regressions ◽

The Relationship

This paper draws on data from five sub-Sahara African countries; Uganda, Rwanda, Malawi, Zambia, and Mozambique consisting of 10,041 married women who were cohabitating with a male spouse. The study aim was to investigate the relationship between women’s empowerment and women’s dietary diversity and consumption of different food items. Women’s empowerment was measured using the indicators in the five domains of Women’s Empowerment in Agriculture index (WEAI) and women’s dietary diversity and food consumption was examined using the women’s dietary diversity score (WDDS) measure. OLS and LPM regressions were used and analyses were confirmed using marginal effects from Poisson and logistic regressions. Results suggest that three out of the 10 WEAI indicators of empowerment showed different magnitude and direction in significant associations with improved WDDS and varied associations were found in three out of the five countries examined. In addition, the three significant empowerment indicators were associated with the consumption of different food groups in three out of the five countries examined suggesting that diverse food groups account for the association between the WEAI and WDDS. Improved autonomy, and input in production were associated with improved likelihoods of consumption of dairy products, and fruits and vegetables including vitamin A-rich produce. Empowerment in public speaking was associated with improved consumption of other fruits and vegetables including vitamin A-rich produce. The varied nature of empowerment indicators towards improving women’s dietary diversity and food consumption suggests that different empowerment strategies might confer different benefits towards the consumption of different food groups. Further, findings imply that interventions that seek to empower women should tailor their strategies on existing contextual factors that impact on women

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Differences in Estimates of Minimum Dietary Diversity by Using the New and Old Definition: Evidence From Bangladesh

Current Developments in Nutrition ◽

10.1093/cdn/nzab046_105 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 808-808

Author(s):

Abhijeet Roy ◽

Md Mokbul Hossain ◽

Md Showkat Ali Khan ◽

Abu abdullah Mohammad Hanif ◽

Mehedi Hasan ◽

...

Keyword(s):

Breast Milk ◽

Urban Areas ◽

Dietary Diversity ◽

Age Groups ◽

Wealth Index ◽

Food Group ◽

Family Welfare ◽

Food Groups ◽

Definition Of ◽

Minimum Dietary Diversity

Abstract Objectives Minimum Dietary Diversity (MDD) is an indicator to assess feeding practices of children aged 6–23 months. The WHO and UNICEF have recently revised the definition of MDD, replacing ‘≥4 out of 7 food groups (MDD-7FG)’ with ‘≥5 out of 8 food groups (MDD-8FG)’. In the new definition, breast milk was considered as a separate food group. We aimed to estimate the implications of this change on the prevalence of MDD at the national and regional levels of Bangladesh. Methods We analyzed data from the national food security and nutrition surveillance round 2018–2019. MDD was defined and calculated according to the WHO-UNICEF guidelines. The prevalence of MDD-7FG and MDD-8FG was estimated and stratified by gender, age groups, place of residence, division, and wealth index. The difference between the prevalence between MDD-7FG and MDD-8FG was presented as percentages. Results Compared to the older definition, the overall prevalence of MDD was lower among 6 to 23 months old children in Bangladesh (46.2% vs. 54.7%). The absolute percentage point difference between the estimates (MDD-8FG vs. MDD-7FG) was higher among the boys (44.0% vs. 53.2%), 12–23 months aged old children (53.4% vs. 63.4%), children living in the non-slum urban areas (30.2% vs. 42.4%) and Dhaka division (42.0% vs. 56.3%), and among the children of middle-class families (40.3% vs. 57.6%). Conclusions The new definition and the inclusion of breast milk intake as a new food group led to a decrease in the prevalence of minimum dietary diversity in Bangladesh. The country program needs to emphasize the continuation of breastfeeding until two years of age of the children. Moreover, the changes in the definition of MDD and the resultant consequence should be kept in mind while performing trend analysis of dietary diversity in Bangladesh and elsewhere. Funding Sources Ministry of Health and Family Welfare, Government of Bangladesh.

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Socioeconomic and Geographic Pattern of Food Consumption and Dietary Diversity among Children Aged 6–23 Months Old in Ghana

Nutrients ◽

10.3390/nu13020603 ◽

2021 ◽

Vol 13 (2) ◽

pp. 603

Author(s):

Isaac Anane ◽

Fengying Nie ◽

Jiaqi Huang

Keyword(s):

Socioeconomic Status ◽

Food Consumption ◽

Child Nutrition ◽

Fruits And Vegetables ◽

Dietary Diversity ◽

Geographical Location ◽

Final Analysis ◽

Food Groups ◽

Cross Sectional ◽

Dairy Consumption

Dietary inadequacy is a major challenge among young children in Ghana. Nutritional policies are required for optimum child nutrition and development. This study explored food consumption and dietary diversity by socioeconomic status and geographical location among children aged 6–23 months in Ghana. We used the latest national representative, cross-sectional data from the Ghana Demographic and Health Survey (GDHS-2014). A total of 887 children aged 6–23 months were used in the final analysis. The survey collected data on children’s food consumption through their mothers in the 24 h recall method. Multiple logistic regression models were used to assess the relationship between socioeconomic status and geographical location with food consumption and adequate dietary diversity after adjusting for control variables. The study revealed an association between specific food item consumption, food groups, and dietary diversity by socioeconomic and geographic characteristics. However, dairy consumption increased faster than other nutritional foods when socioeconomic status increased. Furthermore, the study revealed that children’s chances of consuming particular food items and food groups differed across Ghana’s 10 regions. The average probabilities of consuming adequate dietary diversity between the Greater Accra region and Ashanti region were 43% vs. 8% (p < 0.001). Consumption of grains, root, and tubers were relatively higher but low for Vitamin A-rich fruits and vegetables and legumes and nuts for children aged 6–23 months in Ghana. Overall, the mean dietary diversity score was low (3.39; 95% CI: 3.30–3.49) out of eight food groups, and the prevalence of adequate dietary diversity was 22% only. There is a need for policy interventions to ensure appropriate dietary practices to promote healthy growth of children.

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Pattern and Extent of Street Food Consumption in Hohoe, Volta Region, Ghana: A Community-Based Cross-Sectional Survey

Journal of Food Quality ◽

10.1155/2020/7131847 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Winnifred Ekua Baidoe ◽

Mark Kwame Ananga ◽

Elorm Kwame Nyinaku

Keyword(s):

Food Consumption ◽

Dietary Diversity ◽

Sampling Technique ◽

Food Group ◽

Daily Basis ◽

Food Groups ◽

Cross Sectional Survey ◽

Chi Square ◽

Cross Sectional ◽

Street Food

Background. For most people in developing countries, street food is a major source of sustenance, and Ghana is no exception. Street food vending has seen tremendous growth in Ghana as a result of the insurgence of urbanisation. Despite being one of the largest sectors of national economy in terms of employment and sales of food, very little is known about street food consumption patterns in Ghana. The current study explored the patterns and extent of street food consumption in the Hohoe township. Methods. A cross-sectional design which recruited 403 subjects through a multistage sampling technique. A semistructured questionnaire was used to gather information on demographics, types of street foods, extent of street food consumption, safety concerns, and diversity of street foods patronised. Means, standard deviations, and Chi-square tests were used to determine the association between selected variables at <0.05 level of significance. Results. The top 5 foods mostly patronised by respondents are porridge foods-Koko (17.9%), rice and stew (17.4%), banku (12.6%), waakye (11.5%), and kenkey (8.7%) with porridge foods consumed almost on a daily basis. Convenience (37.2%) and affordability (17.1%) greatly influenced the choice of street foods among consumers. Occupation and the level of education are strongly correlated with the concern for safety of street foods {(X2 = 17.3094, P<0.008); (X2 = 17.1731, P<0.002)}. The dietary diversity score of most respondents was in the high tercile (77.7%) (≥6 food groups), whilst the cereals dominate the food group mostly consumed by respondents. Conclusion. The study suggests that patronising street food is very high in Hohoe municipality, irrespective of the gender, occupation, or educational level. As an “informal” sector of food business, street foods often escape formal inspection and control. They can, therefore, both be the source of food safety problems and contribute to the deterioration of environmental hygiene. This is a call on policy makers and regulators to take a critical look at the sector.

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Using National Survey Data From Nigeria to Assess Maternal-Child Dietary Concordance and Inform Nutrition Program Strategy

Current Developments in Nutrition ◽

10.1093/cdn/nzab038_001 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 389-389

Author(s):

Nadia Akseer ◽

Rebecca A Heidkamp ◽

Andrew Thorne-Lyman

Keyword(s):

Maternal Education ◽

Fruits And Vegetables ◽

Dietary Diversity ◽

Maternal Diet ◽

Food Group ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Food Groups ◽

Diet Diversity ◽

Maternal Child

Abstract Objectives Improving child diet diversity is a policy priority in many settings. Multiple factors influence complementary feeding practices in low-income countries including household food access, caregiver-level factors and cultural practices. Child's dietary data is often available in national surveys (i.e., Demographic and Health Surveys, DHS), but they typically lack diet data from adults. The 2018 Nigeria DHS was among the first to measure food group intake in both young children and women. We describe the relationship between child and maternal diet diversity in Nigeria and highlight implications for design of infant and young child feeding (IYCF) programs. Methods Using the Nigeria DHS 2018 dataset, we estimated consumption of individual food groups in the previous 24 hours as well as minimum dietary diversity for children 6–23 months (MDD-C) and their mothers, women 15–49 years (MDD-W) using WHO-UNICEF definitions. We compare rates of concordance and discordance between n = 8975 mother-child pairs for individual food groups and MDD using McNemar's tests. Probit regression was used to identify drivers of MDD-C. Results Nationally, 22% of children achieve MDD-C; 51% of mothers achieve MDD-W. For both populations, the most commonly consumed group is grains, roots and tubers (>80%) Dairy and eggs are the least consumed. Maternal-child (age 12–23 months) discordance is highest for consumption of legumes and nuts (36%), vitamin A rich fruits and vegetables (39%) and other fruits and vegetables (57%); mothers consume these more frequently. Children are more likely than mothers to consume dairy (19% vs 8%) and eggs (8% vs 4%). Maternal-child food group discordance is consistently higher for children 6–11months than children 12–23 months. Results vary at state level and by maternal age group. Children's MDD probability is increased by MDD-W (27%, P < 0.001), higher maternal education (8%, P < 0.01) and household wealth (7%, P < 0.01). Conclusions Maternal and child diet diversity is suboptimal in Nigeria. Maternal diet is a primary driver of child diet in Nigeria. Legumes and nuts and fruits and vegetables are available but not consistently fed to children; an important finding for IYCF program design. The forthcoming DHS-8 core questionnaire will provide child and maternal diet data for more than 90 countries. Funding Sources Bill & Melinda Gates Foundation.

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Frequency of takeaway food consumption and its association with major food group consumption, anthropometric measures and blood pressure during adolescence

British Journal Of Nutrition ◽

10.1017/s000711451600101x ◽

2016 ◽

Vol 115 (11) ◽

pp. 2025-2030 ◽

Cited By ~ 5

Author(s):

Bamini Gopinath ◽

Victoria M. Flood ◽

George Burlutsky ◽

Jimmy C. Y. Louie ◽

Louise A. Baur ◽

...

Keyword(s):

Blood Pressure ◽

Food Consumption ◽

Fruits And Vegetables ◽

Vegetable Consumption ◽

Food Group ◽

Food Groups ◽

Anthropometric Indices ◽

Anthropometric Measures ◽

Major Food ◽

Single Question

AbstractWe prospectively assessed the (1) frequency and socio-economic correlates of takeaway food consumption during adolescence; and (2) association between frequent takeaway food consumption with intakes of major food groups and anthropometric measures and blood pressure (BP). In total, 699 Sydney schoolchildren (380 girls and 319 boys) who had dietary data at both 12 and 17 years of age were included for analyses. Takeaway food consumption was self-reported and based on a single question. Anthropometric measures and BP were collected. The proportion of participants who ate takeaway foods once per week or more increased significantly over 5 years from the age of 12 to 17 years: 35·5–44·1 % (P<0·0001). In total, 12-year-old girls compared with boys had reduced odds of takeaway foods once per week or more at the age of 17 years (P=0·01), multivariable-adjusted OR 0·63 (95 % CI 0·44, 0·90). In total, 12-year-old children who ate takeaway foods once per week or more had significantly lower mean fruit (220·3 v. 253·0 g/d; P=0·03) and vegetable consumption (213·2 v. 247·7 g/d; P=0·004), 5 years later (at 17 years of age). Frequent takeaway food consumption at the age of 12 years was not associated with anthropometric indices and BP at the age of 17 years. Consumption of takeaway foods became more frequent during adolescence, particularly among boys, and it was associated with reduced intake of fruits and vegetables.

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

Nutrients ◽

10.3390/nu12072039 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2039 ◽

Cited By ~ 2

Author(s):

Giles T. Hanley-Cook ◽

Ji Yen A. Tung ◽

Isabela F. Sattamini ◽

Pamela A. Marinda ◽

Kong Thong ◽

...

Keyword(s):

Data Collection ◽

Dietary Diversity ◽

Weighted Kappa ◽

Food Group ◽

Reproductive Age ◽

Food Groups ◽

Women Of Reproductive Age ◽

Group Diversity ◽

Minimum Dietary Diversity ◽

Recall Methods

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

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Are Women in Rural India Really Consuming a Less Diverse Diet?

Food and Nutrition Bulletin ◽

10.1177/0379572120943780 ◽

2020 ◽

Vol 41 (3) ◽

pp. 318-331

Author(s):

Soumya Gupta ◽

Naveen Sunder ◽

Prabhu L. Pingali

Keyword(s):

Vitamin A ◽

Fruits And Vegetables ◽

Dietary Diversity ◽

Primary Data ◽

Rural India ◽

Food Groups ◽

Diet Diversity ◽

Household Members ◽

The Difference ◽

Food Consumed

Background: It is widely considered that women have less diverse diets than other household members. However, it has been challenging to establish this empirically since women’s diet diversity is measured differently from that of other household members. Objective: In this article, we compare women’s dietary diversity with that of their respective households and thereby generate a measure of “dietary gap.” Methods: We measure women’s “dietary gap” by using the difference of homogenized household and woman dietary scores (using the same scales). This is done using primary data on 3600 households from 4 districts in India. Additionally, we show the robustness of our results to variations in scale and recall periods used to construct the diet diversity scores. Results: Mean difference tests indicate that women consistently consume 0.1 to 0.5 fewer food groups relative to other household members, with the results being statistically significant at the 1% level. The food groups driving this dietary gap are nonstaples like Vitamin A-rich fruits and vegetables, meat/fish/poultry, and dairy. Conclusions: Results point toward the discrimination faced by women in the variety of the food consumed, the importance of considering comparability in creating indices of diet diversity, and the need to collect more detailed information on diets. To our knowledge, this is one of the first studies to examine dietary discrimination faced by women using common scales.

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Eating Pattern and Nutritional Risks among People with Multiple Sclerosis Following a Modified Paleolithic Diet

Nutrients ◽

10.3390/nu12061844 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1844

Author(s):

Tyler J. Titcomb ◽

Babita Bisht ◽

David D. Moore ◽

Yashpal S. Chhonker ◽

Daryl J. Murry ◽

...

Keyword(s):

Multiple Sclerosis ◽

Vitamin A ◽

Fruits And Vegetables ◽

Disease Risk ◽

Serum Levels ◽

Food Group ◽

Micronutrient Deficiencies ◽

Food Groups ◽

Paleolithic Diet ◽

Eating Pattern

Preliminary studies suggest that a modified Paleolithic diet may benefit symptoms of fatigue in progressive multiple sclerosis (MS). However, this diet restricts the consumption of eggs, dairy, and gluten-containing grains, which may increase the risk of micronutrient deficiencies. Therefore, we evaluated the nutritional safety of this diet among people with progressive MS. Three nonconsecutive 24-h dietary recalls were collected from (n = 19) progressive MS participants in the final months of a diet intervention study and analyzed using Nutrition Data System for Research (NDSR) software. Food group intake was calculated, and intake of micronutrients was evaluated and compared to individual recommendations using Nutrient Adequacy Ratios (NARs). Blood was drawn at baseline and the end of the study to evaluate biomarker changes. Mean intake of fruits and vegetables exceeded nine servings/day and most participants excluded food groups. The intake of all micronutrients from food were above 100% NAR except for vitamin D (29.6 ± 34.6%), choline (73.2 ± 27.2%), and calcium (60.3 ± 22.8%), and one participant (1/19) exceeded the Tolerable Upper Limit (UL) for zinc, one (1/19) for vitamin A, and 37% (7/19) exceeded the chronic disease risk reduction (CDRR) for sodium. When intake from supplements was included in the analysis, several individuals exceeded ULs for magnesium (5/19), zinc (2/19), sodium (7/19), and vitamins A (2/19), D (9/19), C (1/19), B6 (3/19), and niacin (10/19). Serum values of vitamins D, B12, K1, K2, and folate significantly increased compared to respective baseline values, while homocysteine and magnesium values were significantly lower at 12 months. Calcium and vitamin A serum levels did not change. This modified Paleolithic diet is associated with minimal nutritional risks. However, excessive intake from supplements may be of concern.

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