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

Published online by Cambridge University Press:  02 January 2007

NP Steyn*
Affiliation:
Chronic Diseases of Lifestyle Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa
JH Nel
Affiliation:
Department of Logistics, University of Stellenbosch, Stellenbosch, South Africa
G Nantel
Affiliation:
Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
G Kennedy
Affiliation:
Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
D Labadarios
Affiliation:
Department of Human Nutrition, University of Stellenbosch, Stellenbosch and Tygerberg Academic Hospital, Tygervalley, South Africa
*
*Corresponding author: Email nelia.steyn@mrc.ac.za
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Abstract

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Objective

To 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.

Methods

Secondary 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.

Results

The 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.

Conclusion

Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

Type
Research Article
Copyright
Copyright © The Authors 2006

References

1World Health Organization (WHO). World Health Report 2002. Geneva: WHO, 2002.Google Scholar
2Ochoa, TJ, Salazar-Lindo, E, Cleary, TG. Management of children with infection-associated persistent diarrhea. Seminars in Pediatric Infectious Diseases 2004; 15: 229–36.CrossRefGoogle ScholarPubMed
3Pan American Health Organization (PAHO)/World Health Organization (WHO). Guiding Principles for Complementary Feeding of the Breastfed Child. Washington, DC: PAHO/WHO, 2003.Google Scholar
4Hatloy, A, Torheim, LE, Oshaug, A. Food variety – a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. European Journal of Clinical Nutrition 1998; 52: 891–8.CrossRefGoogle Scholar
5Ogle, BM, Hung, PH, Tuyet, HT. Significance of wild vegetables in micronutrient intakes of women in Vietnam: an analysis of food variety. Asia Pacific Journal of Clinical Nutrition 2001; 10: 2130.CrossRefGoogle ScholarPubMed
6Onyango, A, Koski, KG, Tucker, KL. Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. International Journal of Epidemiology 1998; 27 484–9.CrossRefGoogle ScholarPubMed
7Tarini, A, Bakari, S, Delisle, H. The overall quality of the diet is reflected in the growth of Nigerian children. Sante 1999; 9: 2331.Google ScholarPubMed
8Foote, JA, Murphy, SP, Wilkens, LR, Basiotis, PP, Carlson, A. Dietary variety increases the probability of nutrient adequacy among adults. Journal of Nutrition 2004; 134: 1779–85.CrossRefGoogle ScholarPubMed
9Bernstein, MA, Tucker, KL, Ryan, ND, O'Neill, EF, Clements, KM, Nelson, ME, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. Journal of the American Dietetic Association 2002; 102: 1096–104.CrossRefGoogle ScholarPubMed
10Ruel, MT. Operationalizing dietary diversity: a review of measurement issues and research priorities. Journal of Nutrition 2003; 133: S3911–26.CrossRefGoogle ScholarPubMed
11Brown, KH, Peerson, JM, Kimmons, JE, Hotz, C. Options for achieving adequate intake from home-prepared complementary foods in low income countries. In: Black, RE, Fleischer Michaelsen, K, eds. Public Health Issues in Infant and Child Nutrition. Nestle Nutrition Workshop Series, Pediatric Program Vol. 48. Philadelphia, PA: Vevey/Lippincott Williams and Wilkins, 2002; 1022.Google Scholar
12Ferguson, E, Gibson, R, Opare-Obisaw, C, Osei-Opare, C, Lamba, C, Ounpuu, S. Seasonal food consumption patterns and dietary diversity of rural preschool Ghanaian and Malawian children. Ecology of Food and Nutrition 1993; 29: 219–34.CrossRefGoogle Scholar
13Ruel, M, Graham, J, Murphy, S, Allen, L. Validating simple indicators of dietary diversity and animal source food intake that accurately reflect nutrient adequacy in developing countries Report for Global Livestock CRSP, University of California at Davis, 2004.Google Scholar
14Dewey, K, Cohen, R, Arimond, M, Ruel, M. Developing and Validating Indicators of Feeding Frequency and Nutrient Density of Complementary Foods for the Breastfed Child in Developing Countries. Washington, DC/Davis, CA: International Food Policy Research Institute and University of California at Davis, 2004.Google Scholar
15Steyn, NP, Labadarios, D, Maunder, E, Nel, J, Lombard, C, MacIntyre, U, et al. Secondary anthropometric data analyses of the National Food Consumption Survey in South Africa: the double burden. Nutrition 2005; 21: 413.CrossRefGoogle ScholarPubMed
16Labadarios, D, Steyn, NP, Maunder, E, MacIntyre, U, Gericke, G, Swart, R, et al. The National Food Consumption Survey (NFCS): South Africa, 1999. Public Health Nutrition 2005; 8: 533–43.CrossRefGoogle ScholarPubMed
17Rose, D, Meershoek, S, McEwan, M. Evaluation of a rapid field tool for assessing household diet quality in Mozambique. Food and Nutrition Bulletin 2002; 23: 181–9.CrossRefGoogle ScholarPubMed
18Labadarios, D, Steyn, NP, Maunder, E, MacIntyre, U, Swart, R, Gericke, G, et al. The National Food Consumption Survey (NFCS): Children aged 1–9 years in South Africa, 1999. Pretoria: Department of Health, 2000.Google Scholar
19Food and Agriculture Organization (FAO)/World Health Organization (WHO). Human Vitamin and Mineral Requirements. Report of a Joint FAO/WHO Expert Consultation. Rome: FAO, 2002.Google Scholar
20Hahn, NI. Variety is still the spice of life. Journal of the American Dietetic Association 1995; 95: 1096–7.CrossRefGoogle Scholar
21Food and Agriculture Organization/International Life Sciences Institute (ILSI). Preventing Micronutrient Malnutrition: A Guide to Food-based Approaches. Washington, DC: ILSI Press, 1997.Google Scholar
22Tucker, K, Mayer, J. Eat a variety of healthful foods: old advice with new support. Nutrition Reviews 2001; 59: 156–8.Google ScholarPubMed
23Maunder, EMW, Matji, J, Hlatshwayo-Molea, T. Enjoy a variety of foods – difficult but necessary in developing countries, South African Journal of Clinical Nutrition 2001: 14(Suppl. 3): S7–11.Google Scholar
24Kennedy, ET, Ohls, J, Carlson, S, Fleming, K. The healthy eating index: design and applications. Journal of the American Dietetic Association 1995; 95: 1103–8.CrossRefGoogle ScholarPubMed
25Kant, AK. Indexes of overall diet quality: a review. Journal of the American Dietetic Association 1996; 96: 785–91.CrossRefGoogle ScholarPubMed
26Drewnowski, A, Henderson, SA, Shore, AB, Fischler, C, Preziosi, P, Hercberg, S. Diet quality and dietary diversity in France: implications for the French paradox. Journal of the American Dietetic Association 1996; 96: 663–9.CrossRefGoogle ScholarPubMed
27Feskanich, D, Rockett, HRH, Colditz, GA. Modifying the healthy eating index to assess diet quality in children and adolescents. Journal of the American Dietetic Association 2004; 104: 1375–83.CrossRefGoogle ScholarPubMed
28Espeut, D. Knowledge, Practices and Coverage Survey 2000+ Field Guide [online]. Calverton, MD: The Child Survival Technical Support Project, Available at http://www.childsurvival.com/kpc2000/FldGuide_Sept_2003.doc. Accessed 5 June 2005.Google Scholar