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Molani-Gol R, Kheirouri S, Alizadeh M. Does the high dietary diversity score predict dietary micronutrients adequacy in children under 5 years old? A systematic review. J Health Popul Nutr 2023; 42:2. [PMID: 36609429 PMCID: PMC9817313 DOI: 10.1186/s41043-022-00337-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Roghayeh Molani-Gol
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St., POBOX: 14711, Tabriz, 5166614711 Iran
| | - Sorayya Kheirouri
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St., POBOX: 14711, Tabriz, 5166614711 Iran
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St., POBOX: 14711, Tabriz, 5166614711 Iran
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Kruger R, Hepburn AJ, Beck KL, McNaughton S, Stonehouse W. Evaluating a novel dietary diversity questionnaire to assess dietary diversity and adequacy of New Zealand women. Nutrition 2021; 91-92:111468. [PMID: 34597853 DOI: 10.1016/j.nut.2021.111468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We sought to develop and evaluate the relative validity of a dietary diversity questionnaire (DDQ) that reflects food-group diversity, food variety, and micronutrient adequacy among New Zealand women. METHODS A cross-sectional study included New Zealand women (Auckland based; ages 16-45 y, n = 101), completing a 7-d DDQ and 4-d weighed food record (reference method). The relative validity of the DDQ was evaluated by correlating nutritious and discretionary dietary diversity scores (DDSs; number of food groups) and food-variety scores (number of foods), calculated from both methods. The dietary mean adequacy ratio (MAR; micronutrient intakes relative to estimated average requirements) was calculated from the weighed food record and correlated to dietary diversity and food-variety scores from the DDQ to assess construct validity. Cross-tabulation was used to explore dietary diversity measures versus adequacy ratios. Significance was set at P < 0.05. RESULTS The median (interquartile range) DDSs (maximum 25) from the DDQ-23 (21-23)-and the weighed food record-18 (17-19)-were significantly correlated (rs = 0.33, P < 0.001), as were the food-variety scores (maximum 237)-respectively, 75 (61-87) and 45 (37-52) (rs = 0.22, P < 0.03). A mean (± SD) MAR of 0.94 ± 0.04 suggested a near-adequate diet, but one-third of foods consumed were from discretionary sources. Nutritious DDS was significantly correlated with MAR for micronutrients (rs = 0.20, P ≤ 0.05). An inverse trend was observed between discretionary DDS and MAR. CONCLUSIONS The DDQ is a quick, low-burden tool for describing nutritious and discretionary dietary diversity reflecting micronutrient adequacy in high-income settings. It requires further validation across different time frames, population groups, and settings.
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Affiliation(s)
- Rozanne Kruger
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand.
| | | | - Kathryn Louise Beck
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Sarah McNaughton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Welma Stonehouse
- Commonwealth Scientific and Industrial Research Organization, Adelaide, Australia
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Yeneabat T, Adugna H, Asmamaw T, Wubetu M, Admas M, Hailu G, Bedaso A, Amare T. Maternal dietary diversity and micronutrient adequacy during pregnancy and related factors in East Gojjam Zone, Northwest Ethiopia, 2016. BMC Pregnancy Childbirth 2019; 19:173. [PMID: 31092223 PMCID: PMC6521398 DOI: 10.1186/s12884-019-2299-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Monotonous and less diversified diets are associated with micronutrient deficiency. Evidence on maternal dietary intakes during pregnancy is essential to achieve the 2025 global nutrition target and reduce maternal and child mortalities. This study assessed pregnant women’s dietary diversity and identified factors associated with inadequate dietary diversity in East Gojjam Zone. Methods We conducted a community-based cross-sectional study between April and June 2016. Eight hundred thirty-four pregnant women were randomly sampled. The Women Dietary Diversity Score tool developed by the Food and Agricultural Organization (FAO) and Food and Nutrition Technical Assistance (FANTA) was used. Data were entered into EpiData with double entry verification, and analysis was done using IBM SPSS version 20. Level of significance was set to P < 0.05 with 95% confidence interval (CI) to identify the independent factors associated with inadequate dietary diversity. Results The mean (±SD) dietary diversity score was 3.68 (±2.10). Inadequate dietary diversity was prevalent in 55% [95% CI (52.3–59.3%)] of pregnant women, or indirectly micronutrient was inadequate in more than half of the pregnant women. Commonly consumed dietary groups were legumes, nuts, and seeds (85.5%) followed by starchy staples (64.7%). Inadequate dietary diversity was higher among non-educated [Adjusted Odds Ratio (AOR) = 7.30, 95% CI (2.35–22.68)] compared to college and above completed women. Wealth index had significant association with dietary diversity, in which women in the poorest [AOR = 8.83, 95% CI, (1.60–48.61)], poorer [AOR = 6.34, 95% CI (1.16–34.65)], poor [AOR = 8.46, 95% CI (1.56–45.70)], and richer [AOR = 6.57, 95% CI (2.16–20.01)] had higher odds of inadequate dietary diversity. Those who had not received dietary counseling had three folds [AOR = 3.31, 95% CI (1.49–7.35)] of inadequate dietary diversity compared to their counterparts. Less likelihood of inadequate dietary diversity was among women with an increased meal frequency [AOR = 0.53, 95% CI (0.38–0.74)]. Conclusion Consumption of less diversified food during pregnancy is common in the study area. Adequacy of micronutrients is insufficient for more than half of the studied pregnant women. We conclude that being non-educated affects pregnant women to depend on less diversified diet. Providing dietary counseling during pregnancy can improve nutritional practice for pregnant women.
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Affiliation(s)
- Tebikew Yeneabat
- Department of Midwifery, Health Science College, Debre Markos University, Debre Markos, Ethiopia.
| | - Haweni Adugna
- Department of Nursing and Midwifery, School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tarekegn Asmamaw
- Mariestpes International Ethiopia, Regional Advisor, Addis Ababa, Ethiopia
| | - Muluken Wubetu
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Melaku Admas
- Department of Midwifery, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Getachew Hailu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Asres Bedaso
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tadele Amare
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Henjum S, Torheim LE, Thorne-Lyman AL, Chandyo R, Fawzi WW, Shrestha PS, Strand TA. Low dietary diversity and micronutrient adequacy among lactating women in a peri-urban area of Nepal. Public Health Nutr 2015; 18:3201-10. [PMID: 25824344 DOI: 10.1017/S1368980015000671] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The main objectives were to assess the adequacy of the micronutrient intakes of lactating women in a peri-urban area in Nepal and to describe the relationships between micronutrient intake adequacy, dietary diversity and sociodemographic variables. DESIGN A cross-sectional survey was performed during 2008-2009. We used 24 h dietary recall to assess dietary intake on three non-consecutive days and calculated the probability of adequacy (PA) of the usual intake of eleven micronutrients and the overall mean probability of adequacy (MPA). A mean dietary diversity score (MDDS) was calculated of eight food groups averaged over 3 d. Multiple linear regression was used to identify the determinants of the MPA. SETTING Bhaktapur municipality, Nepal. SUBJECTS Lactating women (n 500), 17-44 years old, randomly selected. RESULTS The mean usual energy intake was 8464 (sd 1305) kJ/d (2023 (sd 312) kcal/d), while the percentage of energy from protein, fat and carbohydrates was 11 %, 13 % and 76 %, respectively. The mean usual micronutrient intakes were below the estimated average requirements for all micronutrients, with the exception of vitamin C and Zn. The MPA across eleven micronutrients was 0·19 (sd 0·16). The diet was found to be monotonous (MDDS was 3·9 (sd 1·0)) and rice contributed to about 60 % of the energy intake. The multiple regression analyses showed that MPA was positively associated with energy intake, dietary diversity, women's educational level and socio-economic status, and was higher in the winter. CONCLUSIONS The low micronutrient intakes are probably explained by low dietary diversity and a low intake of micronutrient-rich foods.
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Sánchez-Tainta A, Zazpe I, Bes-Rastrollo M, Salas-Salvadó J, Bullo M, Sorlí JV, Corella D, Covas MI, Arós F, Gutierrez-Bedmar M, Fiol M, de la Corte FG, Serra-Majem L, Pinto X, Schröeder H, Ros E, López-Sabater MC, Estruch R, Martínez-González MA. Nutritional adequacy according to carbohydrates and fat quality. Eur J Nutr 2015; 55:93-106. [PMID: 25616935 DOI: 10.1007/s00394-014-0828-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the association between carbohydrate quality, fat quality or adherence to the Mediterranean diet and intake adequacy of 19 micronutrients in the PREDIMED (PREvención con DIeta MEDiterránea) trial, a multicenter, randomized, controlled, parallel group and primary prevention trial conducted in Spain. METHODS We assessed baseline dietary intake of 6,542 elderly subjects at high cardiovascular risk through a validated food frequency questionnaire (FFQ) and a validated 14-item Mediterranean diet (Med-diet) score. We used a multidimensional carbohydrate quality index (CQI) using four criteria and a fat quality index (FQI) according to the ratio (MUFA + PUFA)/(SFA + TFA). The probability of intake adequacy was calculated comparing the intakes to DRI, and also using the probabilistic approach. Absolute and adjusted probability of having inadequate intake for either ≥6 DRI or ≥8 DRI were estimated to assess nutritional adequacy according to quintiles of each index. RESULTS The lowest prevalence of inadequate micronutrient intake (≥8 DRI) was found in the highest quintile of CQI or Med-diet score, and in the lowest quintile of FQI (adjusted fold risk: 1.4, 3.4 and 10.2 respectively in comparison with the lowest quintile). P for trend <0.001 in three multivariable models. A higher CQI or Med-Diet score and a lower FQI were significantly associated with a lower fold risk of unmet EAR values. CONCLUSIONS A multidimensional assessment of CQI can be a useful tool to evaluate the quality of carbohydrates. This score and a 14-item Med-diet score were positively related to overall micronutrient adequacy in elderly participants.
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Affiliation(s)
- Ana Sánchez-Tainta
- Department of Preventive Medicine and Public Health, School of Medicine-Clinica Universidad de Navarra, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra, Spain.
| | - Itziar Zazpe
- Department of Preventive Medicine and Public Health, School of Medicine-Clinica Universidad de Navarra, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra, Spain.
- Department of Nutrition and Food Sciences, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra, Spain.
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine-Clinica Universidad de Navarra, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra, Spain.
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
| | - Jordi Salas-Salvadó
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Human Nutrition Unit, Sant Joan Hospital, IISPV, Universitat Rovira i Virgili, Reus, Spain.
| | - Mónica Bullo
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Human Nutrition Department, University Rovira i Virgili, Reus, Spain.
| | - José Vicente Sorlí
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
- Primary Care Division, Valencia Institute of Health and Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Dolores Corella
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Department of Preventive Medicine, University of Valencia, Valencia, Spain.
| | - M Isabel Covas
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Cardiovascular Epidemiology Unit, Municipal Institute for Medical Research (IMIM), Barcelona, Spain.
| | - Fernando Arós
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Department of Cardiology, University Hospital Txagorritxu-University Hospital of Alava, Vitoria, Spain.
| | - Mario Gutierrez-Bedmar
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Department of Preventive Medicine and Public Health, University of Málaga, Málaga, Spain.
| | - Miquel Fiol
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Son Espases, Palma de Mallorca, Spain.
| | - F García de la Corte
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Primary Care Division of Sevilla, Department of Family Medicine, San Pablo Health Center, Sevilla, Spain.
| | - Lluis Serra-Majem
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Xavier Pinto
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - Helmut Schröeder
- IMIM-Hospital del Mar Medical Research Institute and CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.
- Instituto de Salud Carlos III, Madrid, Spain.
| | - Emilio Ros
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Lipid Clinic, Department of Endocrinology and Nutrition, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
| | - M Carmen López-Sabater
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain.
| | - Ramón Estruch
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
- Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Miguel Angel Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine-Clinica Universidad de Navarra, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra, Spain.
- Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain.
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Steyn NP, Nel J, Labadarios D, Maunder EMW, Kruger HS. Which dietary diversity indicator is best to assess micronutrient adequacy in children 1 to 9 y? Nutrition 2014; 30:55-60. [PMID: 24290599 DOI: 10.1016/j.nut.2013.06.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/24/2013] [Accepted: 06/12/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the best dietary diversity indicator to measure dietary diversity and micronutrient adequacy in children. METHODS A national representative cross-sectional survey of children ages 1 to 9 y (N = 2,200) was undertaken in all ethnic groups in South Africa. A 24-h recall was done with the mother or caregiver of each child. A dietary diversity score (DDS), the number of food groups consumed at least once in a period of 24 h, was calculated for each child in accordance with 6-, 9-, 13-, and 21-food group (G) indicators and compared with a mean adequacy ratio (MAR). The nutrient adequacy ratio (NAR) was calculated for 11 micronutrients by comparing the distributions of estimated intakes with the Estimated Average Requirements for that micronutrient. The MAR was the average of all NARs. Correlations were done between MAR and DDS and sensitivity and specificity calculated for each group indicator. RESULTS Pearson's correlations between food group indicators and MAR indicate that r values were all highly significant (P < 0.0001). There were no consistent or large differences found between the different group indicators although G13 and G21 appeared to be marginally better. Sensitivity and specificity values in the current study lay between DDS of 3 and 5, suggesting one of these as the best indication of (low) micronutrient adequacy. CONCLUSIONS Overall results seem to indicate that any of the four G indicators can be used in dietary assessment studies on children, with G13 and G21 being marginally better. A cut-off DDS of 4 and 5, respectively, appear best.
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Affiliation(s)
- Nelia Patricia Steyn
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa.
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