Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.

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 ¼ 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 ¼ 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 ¼ 0.726; P , 0.0001) and DDS (r ¼ 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.

Objective: To provide an overview of the household dietary diversity score and the food consumption score, two indicators used for food security assessment and surveillance, and compare their performance in food security assessments in three countries. Design: Cross-sectional cluster sampling design using an interview-administered structured questionnaire on household food security, including household-level food group consumption measured over 1 d and 7 d. Setting: Survey data are from Burkina Faso, Lao People's Democratic Republic (Lao PDR) and northern Uganda. Subjects: Households in Burkina Faso (n 3640), Lao PDR (n 3913) and northern Uganda (n 1956). Results: Spearman's correlation coefficients between the scores were 0?73 in Burkina Faso, 0?65 in Lao PDR and 0?53 in northern Uganda. Prevalence-adjusted kappa coefficients showed substantial strength of agreement in two countries. The proportion of agreement between the two scores ranged from 85 % in Lao PDR to 65 % in northern Uganda. Dietary profiles based on food group consumption using score tertiles were comparable. Rankings of the most foodinsecure areas within a country corresponded well in northern Uganda and Burkina Faso but not in Lao PDR. Both indicators showed moderate correlations with other proxy measures of food security. Conclusions: The comparative study highlights the similarities and differences between the food consumption and household dietary diversity scores. Similar classification of the most food-insecure areas within sub-national levels was obtained. The choice of indicator for food security assessment and surveillance will vary depending on user needs. Keywords Household food security Household food access Dietary diversity Food consumptionMany organizations involved in food security assessments use qualitative instead of quantitative measures of dietary intake. Quantitative dietary assessment techniques use data collected primarily at individual level to calculate dietary energy and nutrient intakes, which are then compared with nutrient requirements. Quantitative dietary survey methods are difficult to implement, particularly in developing countries, due to cost, logistics and other considerations such as respondent burden (1) . Qualitative measures of household food consumption, such as dietary diversity and food consumption scores, are attractive as the information required for their construction is less time-consuming and costly to collect than that for quantitative dietary intake methods.Both the FAO and the World Food Programme (WFP) use information on dietary diversity as one element to inform food security analysis; however, the organizations use different data collection methods and analytical strategies (2)(3)(4) . The FAO uses a 1 d household dietary diversity score (HDDS) based on guidelines produced by the Food and Nutrition Technical Assistance Project (5) and the WFP uses a food consumption score (FCS). Both the HDDS and the FCS have been validated in different countries as proxy measures of household per ca...

Micronutrient malnutrition remains a problem of public health concern in most developing countries, partly due to monotonous, cereal-based diets that lack diversity. The study objective was to assess whether dietary diversity score (DDS) based on a simple count of food groups consumed and DDS using a 10-g minimum intake for each food group (DDS 10g) are good indicators of adequate micronutrient intake in 24-71-mo-old non-breast-feeding Filipino children. Pearson's correlation and linear regression were used to assess the utility of DDS and DDS 10g as indicators of micronutrient intake. Sensitivity and specificity analysis were used to determine the most appropriate cut-off point for using DDS to categorize children with high probability of adequate micronutrient intake. The average diet of the sample population consisted of 4-5 food groups. The mean probability of adequate nutrient intake (MPA) of 11 micronutrients was 33%. The Pearson's correlation coefficient between MPA and DDS was 0.36 (P<0.001) and for DDS 10g it increased to 0.44 (P<0.001). Intake of individual micronutrients was correlated to DDS for most nutrients. When maximizing sensitivity and specificity, the best cut-off points for achieving 50 and 75% probability of adequate micronutrient intake were 5 and 6 food groups, respectively. DDS and DDS 10g were both significant predictors of adequate micronutrient intake. This study demonstrates the utility of indicators of dietary diversity to predict adequate intake of micronutrients in the diets of young non-breast-feeding children.

SignificanceCurrent research linking biodiversity and human diets has used metrics without justification from a nutritional point of view. Diet species richness, or a count of the number of different species consumed per day, assesses both nutritional adequacy and food biodiversity of diets for women and children in rural areas. The positive association of food species richness with dietary quality was observed in both the wet and the dry season. Food biodiversity contributes to diet quality in vulnerable populations in areas with high biodiversity. Reporting the number of species consumed during dietary assessment provides a unique opportunity to cut across two critical dimensions of sustainable development—human and environmental health—and complements existing indicators for healthy and sustainable diets.

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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. Objective: The aim of the study was to develop a dichotomous indicator of dietary diversity in WRA. 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. 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. 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.

Context Dietary intake research has increasingly focused on improving diet quality in low- and middle-income countries (LMICs). Accompanying this is the need for sound metrics to assess diet quality. Objective This systematic literature review aims to describe existing diet quality indices for general populations and highlights recommendations for developing such indices for food system research in LMICs. Data sources Three electronic databases were searched for papers published between January 2008 and December 2017. Data extraction Articles published in English and describing the development of an index to measure overall diet quality, irrespective of whether they were for high-income countries or LMICs, were included. Data analysis Eighty-one indices were identified, over two thirds were based on national dietary guidelines from high-income countries. Of the 3 key diet quality dimensions, “diversity” was included in all 18 indices developed for LMICs, “moderation” was captured by most, and “nutrient adequacy” was included 4 times. Conclusions Indices need to be developed that include all dimensions, include foods and/or food groups rather than nutrients, use an optimal range for individual components in the score, and express the intake of healthy and unhealthy components separately. Importantly, validation of the index should be part of its development.