Development of a Dichotomous Indicator for Population-Level Assessment of Dietary Diversity in Women of Reproductive Age uri icon

abstract

  • Background: Dietary diversity is a key element of diet quality but diets of women of reproductive age (WRA; 15-49 y) in resource-poor settings are often deficient in a range of micronutrients. Previous work demonstrated relationships between simple food group diversity indicators (FGI) and micronutrient adequacy among WRA. For operational and advocacy purposes, however, there is strong demand for a dichotomous indicator reflecting an acceptable level of dietary diversity. Objective: To develop a dichotomous indicator of dietary diversity among WRA. Methods: We performed a secondary analysis of 9 data sets containing quantitative dietary data from WRA in resource-poor settings (N total = 4,166). From the raw dietary data we calculated an individual "mean probability of adequacy" (MPA) across 11 micronutrients. Several candidate FGI were constructed. Indicator performance in predicting MPA > 0.60 was assessed within each data set using receiver-operating characteristics (ROC) analysis and sensitivity/specificity analysis at various FGI cut-offs. The analysis was performed separately for non-pregnant and non-lactating (NPNL) and for lactating women. Results: We identified 2 "best candidate" dichotomous indicators based on 9- or 10-point food group scores (FGI-9 and FGI-10) with a cut-off of 5 food groups or more. Both were significantly correlated to MPA in each site (P < 0.001). Areas under the curve (AUC) were moderate, ranging from 0.62 to 0.82 among NPNL women and from 0.56 to 0.90 among lactating women. Comparisons of results slightly favored FGI-10 for all women. Conclusions: When resource-intensive dietary methods are not feasible, a simple dichotomous indicator based on a cut-off of >5 of 10 defined food groups reflects "Minimum dietary diversity for women of reproductive age" (MDD-W). According to the conclusions of a consensus meeting of experts, this indicator is well suited for population-level assessment, advocacy, and maybe also for tracking of change in dietary diversity across time
  • Background: Dietary diversity is a key element of diet quality, but diets of women of reproductive age (WRA; aged 15-49 y) in resource-poor settings are often deficient in a range of micronutrients. Previous work showed associations between simple food-group diversity indicators (FGIs) and micronutrient adequacy among WRA. For operational and advocacy purposes, however, there is strong demand for a dichotomous indicator reflecting an acceptable level of dietary diversity.
  • Conclusions: When resource-intensive dietary methods are not feasible, a simple dichotomous indicator based on a cutoff of >= 5 of 10 defined food groups reflects "minimum dietary diversity for women of reproductive age." According to the conclusions of a consensus meeting of experts, this indicator is well suited for population-level assessment, advocacy, and possibly also for tracking of change in dietary diversity across time.
  • Methods: We performed a secondary analysis of 9 data sets containing quantitative dietary data from WRA in resource-poor settings (total n = 4166). From the raw dietary data, we calculated an individual "mean probability of adequacy" (MPA) across 11 micronutrients. Several candidate FGIs were constructed. Indicator performance in predicting an MPA>0.60 was assessed within each data set by using receiver-operating characteristic analysis and sensitivity and specificity analysis at various FGI cutoffs. The analysis was performed separately for nonpregnant and nonlactating (NPNL) women and for lactating women.
  • Objective: The aim of the study was to develop a dichotomous indicator of dietary diversity in WRA.
  • Results: We identified 2 "best candidate" dichotomous indicators on the basis of 9- or 10-point food-group scores (FGI-9 and FGI-10) with a cutoff of >= 5 food groups. Both were significantly correlated to MPA in each site (P<0.001). Areas under the curve were moderate, ranging from 0.62 to 0.82 among NPNL women and from 0.56 to 0.90 among lactating women. Comparisons of results slightly favored FGI-10 for all women.

publication date

  • 2017
  • 2017
  • 2017