Food group diversity and nutrient adequacy: Dietary diversity as a proxy for micronutrient adequacy for different age and sex groups in Mexico and China

Abstract Objectives We aimed to develop and evaluate an easily-tabulated metric that is sensitive to diet quality in diverse settings. In this analysis, we examined associations between a novel food-based metric – the Global Diet Quality Score (GDQS) - and diet quality using data from rural Africa. Methods The GDQS gives points for higher intake of 16 healthy food groups and lower intake of 9 unhealthy groups, based on 3 intake ranges for each group. We scored the GDQS using food frequency questionnaire (FFQ) data from 1613 men and 1710 nonpregnant nonlactating women ages 15–49 (median: 30) in 12 rural African villages participating in the Millennium Villages Project in 2006 to 2009. We evaluated associations between the GDQS and nutrient intakes calculated from the same FFQ, body mass index (BMI), mid-upper arm circumference (MUAC), hemoglobin, and an overall nutrient adequacy score ranging from 0 to 7 (1 point given for each of 7 nutrients meeting average requirements). Associations were also derived for GDQS submetrics (GDQS+ and GDQS−) computed using only healthy or unhealthy food groups, respectively, and simplified versions of the GDQS and submetrics (scored using 2 intake ranges for each food group). Results Moderate rank correlations were observed between the GDQS+ and energy-adjusted intakes of fiber (women: 0.43, men: 0.33), folate (0.40, 0.30), vitamin A (0.40, 0.34), and zinc (0.38, 0.30), exceeding correlations with the Minimum Dietary Diversity Score for Women (p for difference between metrics <0.05 for fiber and folate in both sexes). The simplified GDQS- correlated moderately with energy-adjusted saturated fat intake (women: 0.35, men: 0.29). Rank correlations between the GDQS+ and overall nutrient adequacy score differed notably by country (range: 0.34–0.75), but not by age or season. Adjusting for age, interview month, and household size, the GDQS and GDQS+ were associated with hemoglobin and anemia (p for difference between metrics >0.05): women and men in the highest GDQS+ quintile had an OR of anemia of 0.25 (95% CI 0.09, 0.68) and 0.16 (95% CI 0.04, 0.46), respectively, relative to those in the lowest. Metrics were not associated with BMI or MUAC in adjusted analyses. Conclusions The GDQS and submetrics were associated with nutrient intakes, hemoglobin, and reduced anemia in rural African adults. Funding Sources Intake - Center for Dietary Assessment at FHI Solutions.

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Dietary Diversity and Prostate Cancer in a Spanish Adult Population: CAPLIFE Study

Nutrients ◽

10.3390/nu12061694 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1694

Author(s):

Naomi Cano-Ibáñez ◽

Rocío Barrios-Rodríguez ◽

Macarena Lozano-Lorca ◽

Fernando Vázquez-Alonso ◽

Miguel Arrabal-Martín ◽

...

Keyword(s):

Prostate Cancer ◽

Nutrient Intake ◽

Dietary Diversity ◽

Adult Population ◽

Food Group ◽

Population Based ◽

Logistic Regression Models ◽

Nutrient Adequacy ◽

Protein Group ◽

Adequate Nutrient

Dietary diversity (DD) is a key component of a high-quality diet, providing the adequate nutrient requirements. However, the role of DD on prostate cancer (PCa) is still uncertain. The aim of this study was to evaluate the relationship between DD, adequate nutrient intake and PCa, according to the aggressiveness of the tumor. The CAPLIFE (CAP: prostate cancer; LIFE: lifestyles) study is a population-based case-control study including a total of 402 incident PCa cases and 302 controls. The DD score (DDS), adjusted by total energy intake, was collected through a validated food frequency questionnaire. Nutrient adequacy was defined according to European Dietary Recommendation Intake for men. The aggressiveness of PCa was determined according to the International Society of Urology Pathology classification. The association between DDS, nutrient intake and PCa was assessed by logistic regression models with adjustment for potential confounding factors. DDS was similar for PCa cases and controls, independent of PCa aggressiveness. According to each food group DDS, the protein group showed the highest mean score in all the subgroups analyzed. However, no differences were observed for each of the DDS components. The DDS, the variety of the group’s food intake, and the adequate nutrient intake, were not associated with PCa.

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

Public Health Nutrition ◽

10.1079/phn2005912 ◽

2006 ◽

Vol 9 (5) ◽

pp. 644-650 ◽

Cited By ~ 328

Author(s):

NP Steyn ◽

JH Nel ◽

G Nantel ◽

G Kennedy ◽

D Labadarios

Keyword(s):

Sensitivity And Specificity ◽

Dietary Diversity ◽

Pearson Correlation ◽

Child Growth ◽

World Health ◽

Food Groups ◽

Nutrient Adequacy ◽

Z Scores ◽

Food Variety ◽

The Mean

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

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Do Dietary Diversity Indices Reflect the Nutritional Status of School Aged Children?

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2016.53.4.8399 ◽

2016 ◽

Vol 53 (4) ◽

pp. 405 ◽

Cited By ~ 1

Author(s):

D. J. Nithya ◽

R. V. Bhavani

Keyword(s):

Nutritional Status ◽

School Children ◽

Dietary Diversity ◽

Good Health ◽

Diversity Indices ◽

Food Groups ◽

Anthropometric Indices ◽

Nutrient Adequacy ◽

School Aged Children ◽

The Mean

Dietary Diversity, with foods from all food groups is necessary to meet the requirements for essential nutrients which lead to good health. This study examines whether different dietary diversity indices have relationship with the nutritional status of school children aged 6 to 12 years, in two different regions of India: Wardha district, Maharashtra and Koraput district, Odisha. Dietary diversity was calculated using three methods: Individual food scores calculated using 24 hour diet recall (FS24hr) data; household dietary diversity using Berry's index (DDI) and food scores calculated using food frequency data (FSFFQ). Anthropometric indices were used to assess the nutritional status of school aged children. The Nutrient Adequacy Ratio (NAR) and the Mean Adequacy Ratio (MAR) were calculated as indicators of nutrient adequacy. The relationship between NAR, MAR and three different diversity indices, dietary diversity and anthropometric indices were analyzed. Overall, 38% of 6 to 12 year school aged children were found to be undernourished. The NAR was <70% for all nutrients except protein, energy, thiamine and niacin and MAR was found to be <70% of requirement with mean of 60.5% in both locations. The dietary diversity was found to be relatively better in Wardha when compared with Koraput. The mean diversity indices in both the locations were FS24hr 7.56, DDI 89 and FSFFQ 62.9. Overall most of the nutrient adequacy and mean adequacy were correlated with all three dietary diversity indices when both locations were studied together. However all three dietary diversity indices failed to show any relationship with nutritional status of school children aged 6-12 years from both locations taken together.

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Impact of Rural-Urban Migration on the Food Consumption Pattern of Farming Households in Ibadan/Ibarapa Agricultural Zone of Oyo State, Nigeria

Developing Sustainable Food Systems, Policies, and Securities - Practice, Progress, and Proficiency in Sustainability ◽

10.4018/978-1-7998-2599-9.ch013 ◽

2020 ◽

pp. 216-238

Author(s):

Fatai Abiola Sowunmi ◽

Funmi Lydia Adeduntan

Keyword(s):

Food Consumption ◽

Rural Areas ◽

Dietary Diversity ◽

Diversity Indices ◽

Food Group ◽

Consumption Pattern ◽

Urban Migration ◽

Rural Urban Migration ◽

Farming Households ◽

Food Consumption Pattern

The study examined the impact of rural-urban migration on the food consumption pattern of farming households. The study revealed that 73.8% of the households had migrants, while 80.2% of the migrants were male. The highest level of education of most of the migrants was secondary school (71.4%). The study showed that the major reason (63.3%) for migration was for job. The average remittance sent per year was ₦108,119.14. The study revealed that household expenditure on carbohydrate food group accounted for 54.4% of the total households' expenditure on food. The average dietary diversity indices for the migrant (0.345) and non-migrant (0.346) households were low. The study revealed that migration (short and long term) positively influenced per capita food expenditure of respondent. Despite the remittance from some of the migrants, the need to develop the rural areas in terms of provision of basic infrastructures by government is imperative in order to reduce rural-urban migration.

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A Garden-Based Intervention to Improve Dietary Diversity in Kenyan School Children: Results from a Natural Experiment

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_015 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 810-810 ◽

Cited By ~ 1

Author(s):

Sara Benjamin-Neelon ◽

Tiange Liu ◽

Eve S Puffer ◽

Liz Turner ◽

Daniel Zaltz ◽

...

Keyword(s):

Low Income ◽

Rural Areas ◽

Primary Schools ◽

Dietary Diversity ◽

Food Group ◽

Low Income Countries ◽

Severe Drought ◽

School Gardens ◽

Post Intervention

Abstract Objectives School gardens may improve child diet, but little is known about their effectiveness in rural areas in low-income countries. We evaluated the ability of school gardens to improve child diet in rural Kenya. We hypothesized that children in intervention schools would improve their dietary diversity and specifically their produce intake. Methods An non-government organization installed gardens in 2 primary schools. We selected 2 geographically proximal additional schools as comparisons. We conducted baseline assessments in 2013, prior to garden installation, and follow-up assessments a year later in 2014 in all 4 schools. We measured child dietary intake via a single 24-hour recall. We calculated dietary diversity using the women's dietary diversity score (WDDS) (continuous) and also examined each of the 10 food group components defined as adequate ≥15 g (binary). We conducted marginal linear or logistic regression models using a generalized estimating equation and included an exposure x time interaction to assess differences in outcomes between intervention and comparison schools from baseline to follow up. We controlled for child age, gender, and orphan status. Results We assessed 855 children (n = 438 intervention; n = 417 comparison) at baseline and 688 children (n = 383 intervention; n = 305 comparison) at follow up. Children in intervention schools were 51.8% male, compared to 56.5% in comparison schools. Mean (standard deviation) age was 11.6 (2.1) years in intervention and 11.8 (2.3) years in comparison schools. All children's WDDS worsened post-intervention. In adjusted difference in difference analyses, WDDS did not differ in intervention vs. comparison schools pre- to post-intervention (β 0.04, CI −0.19, 0.27). However, we observed less of a decrease in meeting adequate intake for pulses (OR 2.18, CI 1.18, 4.01) and other fruits (OR 1.55, CI 1.00, 2.40) in intervention versus comparison schools. Conversely, children in comparison schools had less of a decrease in meat, poultry, and fish compared to children in intervention schools (OR 0.67, CI 0.45, 0.99). Conclusions Children's WDDS worsened in all 4 schools, likely due to a severe drought that affected the region in 2014. We observed some differences in intervention vs. comparison children, but cannot attribute these improvements to school gardens. Funding Sources Duke Global Health Institute.

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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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Household Food Insecurity, Dietary Diversity, Stunting, and Anaemia among Left-Behind Children in Poor Rural Areas of China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234778 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4778 ◽

Cited By ~ 3

Author(s):

Yang ◽

Yuan ◽

Yang ◽

Zou ◽

Ji ◽

...

Keyword(s):

Food Insecurity ◽

Rural Areas ◽

Dietary Diversity ◽

Rural China ◽

Nutritional Intervention ◽

Food Group ◽

Hunan Province ◽

Household Food Insecurity ◽

Left Behind ◽

Household Food

Left-behind children (LBC) are a newly emerged social group in China. Poor nutritional status is particularly prominent in this population. However, their food insecurity tends to attract very little attention. This study aims to investigate the relationship between food insecurity and undernutrition (stunting and anaemia) in 3 to 5-year-old LBC in rural China. Face-to-face interviews were administered to 553 LBC caregivers in 40 rural villages of Hunan Province, China. The Household Food Insecurity Access Scale (HFIAS) was used to assess household food insecurity (HFI). Dietary diversity score (DDS) and food group consumption frequency were measured by 24 h-recall and food frequency questionnaires (FFQ). Hemoglobin tests and anthropometric measurements including height and weight were measured by trained health professionals. Logistic regression was constructed to assess the association between household food insecurity and dietary diversity, stunting, and anaemia. A high prevalence of household food insecurity was determined (67.6%). The weighted prevalence of stunting and anaemia were 16.6% and 26.5%, respectively. Food insecurity was positively associate with LBC stunting (severe HFI: OR = 6.50, 95% CI: 2.81, 15.00; moderate HFI: OR = 3.47, 95% CI: 1.60, 7.54), and anaemia (severe HFI: OR = 1.91, 95% CI: 1.02, 3.57). LBC with food insecurity had significantly lower dietary diversity than those who were food-secure (p < 0.001). The prevalence of household food insecurity among LBC in poor rural China is high and is associated with low DDS, stunting, and anaemia. Nutritional intervention programs and policies are urgently needed to reduce household food insecurity and undernutrition for this vulnerable population.

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Plant-Protein Diversity Is Critical to Ensuring the Nutritional Adequacy of Diets When Replacing Animal With Plant Protein: Observed and Modeled Diets of French Adults (INCA3)

Journal of Nutrition ◽

10.1093/jn/nxz252 ◽

2019 ◽

Cited By ~ 3

Author(s):

Marion Salomé ◽

Erwan de Gavelle ◽

Ariane Dufour ◽

Carine Dubuisson ◽

Jean-Luc Volatier ◽

...

Keyword(s):

Protein Intake ◽

Dietary Diversity ◽

Animal Protein ◽

Plant Protein ◽

Animal Origin ◽

National Study ◽

Higher Plant ◽

Protein Diversity ◽

Nutrient Adequacy ◽

Plant Protein Sources

ABSTRACT Background There is a current trend in Western countries toward increasing the intake of plant protein. A higher plant-protein intake has been associated with nutritional and health benefits, but these may depend on the pattern of plant-protein sources. Objective We hypothesized that the diversity of plant foods could be important to nutrient adequacy when increasing plant-protein intake in the diet. Methods Using data on 1341 adults (aged 18–64 y) from a representative French national dietary survey conducted in 2014–2015 (the third Individual and National Study on Food Consumption Survey—INCA3), we studied the links between plant-protein intake, dietary diversity (using various dimensions), and nutrient adequacy [assessed using the PANDiet (Probability of Adequate Nutrient Intake) scoring system, comprising adequacy (AS) and moderation (MS) subscores]. We simulated substituting plant-protein foods for animal-protein foods using different models of plant-protein diversity. Results We found that overall diet quality was weakly associated with total and protein diversity and more strongly with plant-protein diversity. Plant-protein intake was inversely associated with animal-protein intake, and positively with the PANDiet and MS, but not with the AS. Plant-protein intake displayed little diversity, mostly taking the form of grains (61% of plant-protein intake), and this diversity was even less marked under a higher plant-protein intake. Finally, modeled substitutions showed that reducing animal-protein intake increased the MS (by 32%) in a similar manner whichever plant protein was used for substitution, whereas it decreased the AS (by 20%) unless using a highly diversified plant-protein mix. These simulated improvements in overall adequacy included marked decreases in adequacy regarding certain nutrients that are typically of animal origin. Conclusions We conclude that in French adults the current pattern of plant-protein intake is hindering the nutritional benefits of a transition toward more plant protein, indicating that the consumption of plant-protein-based foods other than refined grains should be encouraged.

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