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Gómez G, Monge-Rojas R, Vargas-Quesada R, Previdelli AN, Quesada D, Kovalskys I, Herrera-Cuenca M, Cortes LY, García MCY, Liria-Domínguez R, Rigotti A, Fisberg RM, Ferrari G, Fisberg M, Brenes JC. Exploring the FAO Minimum Dietary Diversity Indicator as a Suitable Proxy of Micronutrient Adequacy in Men and Women Across Reproductive and Non-reproductive Ages in 8 Latin American Countries. Food Nutr Bull 2024:3795721241242920. [PMID: 38807356 DOI: 10.1177/03795721241242920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Women's Dietary Diversity Score (WDDS) is an indicator of dietary diversity, a key component of diet quality in women of reproductive age (WRA). Limited information is available regarding its applicability in other population groups. OBJECTIVE To examine the ability of the Minimum Dietary Diversity for Women (MDD-W) of 5-food groups cutoff to predict micronutrient adequacy in men and women 15 to 65 years old from 8 Latin American countries. METHODS We used a 24-hour recall from 9216 participants in the Latin American Study on Nutrition and Health (ELANS) to determine Dietary Diversity Score (DDS) based on the consumption of 10 food groups. The Mean Probability of Adequacy (MPA) was associated with DDS for the overall sample, for men, WRA, and women of nonreproductive age (WNRA). Sensitivity and specificity analyses were performed to determine if the 5-food groups cutoff point for MDD can be used to correctly identify men, WRA, and WNRA with adequate micronutrient adequacy (MPA ≥ 0.70). RESULTS We found a mean DDS of 4.78 ± 1.33 and an MPA of 0.64 ± 0.16, with 59% of participants showing a diverse diet (DDS ≥ 5). The 5-food groups-cutoff point showed a better balance between sensitivity and specificity predicting an MPA ≥0.70 in men, WRA, and WNRA. MPA was significantly associated with DDS in WRA and for men and WNRA, as well. CONCLUSION The 5-food group MDD, originally intended to be used in WRA, performed equally well in predicting MPA ≥0.70 in men, WRA, and WNRA, and can be used as a proxy of micronutrient adequacy in Latin American population.
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Affiliation(s)
| | - Rafael Monge-Rojas
- Instituto Costarricense de Investigación en Nutrición y Salud (INCIENSA), Tres Ríos, Cartago, Costa Rica
| | - Rulamán Vargas-Quesada
- Instituto Costarricense de Investigación en Nutrición y Salud (INCIENSA), Tres Ríos, Cartago, Costa Rica
| | | | | | - Irina Kovalskys
- Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
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Hanley-Cook GT, Hoogerwerf S, Parraguez JP, Gie SM, Holmes BA. Minimum Dietary Diversity for Adolescents: Multicountry Analysis to Define Food Group Thresholds Predicting Micronutrient Adequacy among Girls and Boys Aged 10-19 Years. Curr Dev Nutr 2024; 8:102097. [PMID: 38419832 PMCID: PMC10899069 DOI: 10.1016/j.cdnut.2024.102097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Adolescents' diets have been overlooked in nutrition information systems, interventions, and policies. The minimum dietary diversity for women (MDD-W) indicator has been validated to signal greater micronutrient adequacy among nonpregnant women from low- and middle-income countries, but there is limited evidence for valid food group thresholds among boys or nonpregnant nonlactating girls. Objective To define a food group threshold that reflects minimum dietary diversity for adolescents. Methods This multicountry study evaluated the test characteristics of a 10-point food group diversity score (FGDS)-underlying MDD-W-and food group thresholds to predict the micronutrient adequacy of diets from single 24-h recalls or food diaries (24-HRs) among 83,935 adolescents aged 10-19 y and repeated 24-HRs among 75,480 adolescents from upper-middle and high-income countries. Results FGDS was lowest among adolescents in lower-middle countries (3.5 ± 1.1) and greatest in high-income countries (5.4 ± 1.3 points). Using single 24-HRs, 1-point increments in FGDS performed identically to predict a higher mean adequacy ratio among boys and girls (5.1 percentage points; 95% confidence interval: 5.0, 5.2; P < 0.001). MDD-W (i.e., ≥5 food groups) performed well in predicting a mean adequacy ratio of >0.60 among adolescents from upper-middle and high-income countries, whereas a ≥4 food group cutoff showed a superior balance between sensitivity, specificity, and percentage correctly classified in low (only girls) and lower-middle-income countries (boys and girls). In contrast, using repeated 24-HRs, the mean probability of adequacy levels among adolescents were too high and homogeneous (i.e., all mean probability of adequacies > 0.60) to define an optimal food group threshold. Conclusions MDD-W can be extended to boys and girls aged 10-19 y from upper-middle and high-income countries. Furthermore, an adapted indicator using a ≥4 food group threshold signals higher micronutrient adequacy in low and lower-middle-income countries. Food group cutoffs to predict the micronutrient adequacy of usual intakes should be validated using repeated 24-HRs in populations where a lower proportion of adolescents meet mean dietary requirements.
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Affiliation(s)
| | - Sara Hoogerwerf
- Food and Nutrition Division (ESN), FAO of the United Nations, Rome, Italy
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Monge-Rojas R, Vargas-Quesada R, Marrón-Ponce JA, Sánchez-Pimienta TG, Batis C, Rodríguez-Ramírez S. Exploring Differences in Dietary Diversity and Micronutrient Adequacy between Costa Rican and Mexican Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:64. [PMID: 38255378 PMCID: PMC10814227 DOI: 10.3390/children11010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Diet diversity becomes especially relevant during adolescence to satisfy the adequate micronutrient intake. Diet diversity (DD) and micronutrient probability of adequacy (PA) were studied in 818 Costa Rican (CR) and 1202 Mexican (MX) adolescents aged 13-18 years. DD was compared using the Minimum Dietary Diversity (MDD) score. Receiver-operating characteristic (ROC) curves were employed to identify the optimal MDD for each sample from the respective countries. The mean MDD for the overall CR sample was 4.17 ± 1.43 points, and for the MX sample, the mean MDD was 4.68 ± 1.48 points. The proportion of adolescents with a DD was significantly higher in Costa Rica than in Mexico (66.5% vs. 55.6%; p < 0.0001). Also, DD was higher in rural Costa Rican adolescents, while no difference was found in the MX adolescents by area of residence. CR adolescents reported significantly higher PA than MX participants for 6 of the 11 micronutrients assessed. The calcium PA in MX adolescents was significantly higher than in the CR sample (MX: 0.84 vs. CR: 0.03; p < 0.0001), while low PA was obtained for iron in both countries (CR: 0.01 vs. MX: 0.07; p < 0.0001). In Costa Rica and Mexico, nutritional interventions and assessing the compliance of food-fortifying programs are needed to improve the PA of diverse micronutrients.
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Affiliation(s)
- Rafael Monge-Rojas
- Nutrition and Health Unit, Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA), Ministry of Health, Tres Ríos 4-2250, Costa Rica;
| | - Rulamán Vargas-Quesada
- Nutrition and Health Unit, Costa Rican Institute for Research and Education on Nutrition and Health (INCIENSA), Ministry of Health, Tres Ríos 4-2250, Costa Rica;
| | - Joaquín Alejandro Marrón-Ponce
- Nutrition and Health Research Center (CINyS), National Institute of Public Health, Mexico (INSP), Cuernavaca 62100, Mexico; (J.A.M.-P.); (C.B.); (S.R.-R.)
| | - Tania G. Sánchez-Pimienta
- CONAHCYT, Nutrition and Health Research Center (CINyS), National Institute of Public Health, Mexico (INSP), Cuernavaca 62100, Mexico
| | - Carolina Batis
- Nutrition and Health Research Center (CINyS), National Institute of Public Health, Mexico (INSP), Cuernavaca 62100, Mexico; (J.A.M.-P.); (C.B.); (S.R.-R.)
| | - Sonia Rodríguez-Ramírez
- Nutrition and Health Research Center (CINyS), National Institute of Public Health, Mexico (INSP), Cuernavaca 62100, Mexico; (J.A.M.-P.); (C.B.); (S.R.-R.)
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Monge-Rojas R, Barboza LA, Vargas-Quesada R. Reducing dietary intake of added sugars could affect the nutritional adequacy of vitamin A in adolescents: the Costa Rica case. BMC Public Health 2023; 23:2503. [PMID: 38097973 PMCID: PMC10720178 DOI: 10.1186/s12889-023-17243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In countries where sugar fortification with vitamin A is mandatory, strategies to reduce the prevalence of overweight/obesity in adolescents that involve lowering added sugar intake could lead to vitamin A inadequate intakes, since vitamin A-fortified sugar for home consumption contributes to a high proportion of this vitamin intake in the adolescent diet. METHODS The study employed a hierarchical linear model to perform a mediation analysis on a cross-sectional sample of adolescents (13-18 years old) in the province of San José, Costa Rica. RESULTS Lowering the total energy intake derived from added sugars to less than 10% significantly increases the prevalence of vitamin A inadequate intake in adolescents by 12.1% (from 29.6% to 41.7%). This is explained by the mediation model in which, the reduced adequacy of vitamin A intake is mediated by a reduction in total energy intake derived from added sugars fortified with vitamin A. CONCLUSIONS The vitamin A fortification of sugar for household consumption should be reassessed according to the current epidemiological profile in Costa Rica to promote strategies that reduce the prevalence of overweight/obesity in adolescents by lowering the consumption of added sugars without affecting vitamin A intake.
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Affiliation(s)
- Rafael Monge-Rojas
- Nutrition and Health Unit, Researcher, Costa Rican Institute for Research and Education On Nutrition and Health (INCIENSA), 4-2250 Tres Ríos, Cartago, Costa Rica.
| | - Luis A Barboza
- Center for Pure and Applied Mathematics (CIMPA), Researcher, Department of Mathematics, Universidad de Costa Rica, San José, 2060, Costa Rica
| | - Rulamán Vargas-Quesada
- Nutrition and Health Unit, Researcher, Costa Rican Institute for Research and Education On Nutrition and Health (INCIENSA), 4-2250 Tres Ríos, Cartago, Costa Rica
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Dello Russo M, Formisano A, Lauria F, Ahrens W, Bogl LH, Eiben G, De Henauw S, Hebestreit A, Intemann T, Hunsberger M, Lissner L, Molnar D, Pala V, Papoutsou S, Santaliestra-Pasias AM, Veidebaum T, Wolters M, Siani A, Russo P. Dietary Diversity and Its Association with Diet Quality and Health Status of European Children, Adolescents, and Adults: Results from the I.Family Study. Foods 2023; 12:4458. [PMID: 38137262 PMCID: PMC10743104 DOI: 10.3390/foods12244458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
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.
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Affiliation(s)
- Marika Dello Russo
- Institute of Food Sciences, National Research Council, 83100 Avellino, Italy; (M.D.R.); (A.F.); (A.S.); (P.R.)
| | - Annarita Formisano
- Institute of Food Sciences, National Research Council, 83100 Avellino, Italy; (M.D.R.); (A.F.); (A.S.); (P.R.)
| | - Fabio Lauria
- Institute of Food Sciences, National Research Council, 83100 Avellino, Italy; (M.D.R.); (A.F.); (A.S.); (P.R.)
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany; (W.A.); (A.H.); (T.I.); (M.W.)
- Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, 28359 Bremen, Germany
| | - Leonie H. Bogl
- School of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland;
- Finnish Institute of Molecular Medicine, University of Helsinki, 00100 Helsinki, Finland
| | - Gabriele Eiben
- Department of Public Health, School of Health Sciences, University of Skövde, 541 28 Skövde, Sweden;
- Department of Public Health and Community Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium;
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany; (W.A.); (A.H.); (T.I.); (M.W.)
| | - Timm Intemann
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany; (W.A.); (A.H.); (T.I.); (M.W.)
| | - Monica Hunsberger
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden; (M.H.); (L.L.)
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden; (M.H.); (L.L.)
| | - Denes Molnar
- Department of Pediatrics, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Valeria Pala
- Department of Preventive and Predictive Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Stalo Papoutsou
- Research and Education Institute of Child Health, Attikis 8, 2027 Strovolos, Cyprus;
| | - Alba M. Santaliestra-Pasias
- NUTRI-GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences and Sports, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, 50009 Zaragoza, Spain;
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Toomas Veidebaum
- National Institute for Health Development, Center of Health and Behavioral Science, 11619 Tallinn, Estonia;
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany; (W.A.); (A.H.); (T.I.); (M.W.)
| | - Alfonso Siani
- Institute of Food Sciences, National Research Council, 83100 Avellino, Italy; (M.D.R.); (A.F.); (A.S.); (P.R.)
| | - Paola Russo
- Institute of Food Sciences, National Research Council, 83100 Avellino, Italy; (M.D.R.); (A.F.); (A.S.); (P.R.)
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