Dietary diversity predicts dietary quality regardless of season in 6–12-month-old infants in south-west Ethiopia

Wondafrash, Mekitie; Huybregts, Lieven; Lachat, Carl; Bouckaert, Kimberley P; Kolsteren, Patrick

doi:10.1017/s1368980016000525

Cited by 19 publications

(21 citation statements)

References 17 publications

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“…We previously found that children who consumed ≤2 food groups were likely to have inadequate micronutrient intake [15]. In the present analysis, the odds of being stunted was significantly higher for those who consumed ≤2 food groups in the previous 24 h. This was observed both among children in the HS and in the pooled data.…”

Section: Discussionsupporting

confidence: 62%

“…To our knowledge, no study has examined the impact of seasonality on these associations. Previously, we found an association of DDS with mean micronutrient density adequacy (MMDA) and the association proved to be stable over two distinct seasons in Southwest Ethiopia [15]. Moreover, having a DDS ≤ 2 was associated with an inadequate intake of micronutrients.…”

Section: Introductionmentioning

confidence: 83%

“…As the interaction of DDS or ICFI with season was not significant (P >0.1), the interaction term was not included in the models. Moreover, a DDS cutoff of ≤2 was used to dichotomize DDS based on a prior sensitivity and specificity analysis [15] and its association with child anthropometry was tested.…”

Section: Discussionmentioning

confidence: 99%

“…Dietary diversity score was used in our analyses as it is or dichotomized. Previous analyses showed that a DDS ≤2 is associated with a low micronutrient intake [15,20,21] which warrants the investigation of its association with growth of infants and young children.…”

Section: Dietary Diversity Scorementioning

confidence: 98%

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Feeding practices and growth among young children during two seasons in rural Ethiopia

et al. 2017

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Background: The use of indices of infant and young child feeding practices to predict growth has generated inconsistent results, possibly through age and seasonal confounding. The aim of this study was to evaluate the association of a dietary diversity score (DDS) and infant and child feeding index (ICFI) with growth among young children in a repeated cross-sectional and a follow-up study in two distinct seasons in rural southwest Ethiopia. Methods: We used a repeated cross-sectional design comparing child feeding practices to nutritional status in 6-12 month old children during harvest (HS; n = 320) and pre-harvest season (PHS; n = 312). In addition, 6-12 month old children from the HS were reassessed 6 months later during PHS. In addition to child anthropometry, child feeding practices were collected using 24-h and 7-day dietary recalls. Results: The mean (±SD) length-for-age z-score (LAZ) of the 6-12 month old children was −0.77 (±1.4) and −1.0 (±1.3) in HS and PHS, respectively, while the mean (±SD) of the follow-up children in PHS was −1.0 (±1.3). The median DDS (IQR) was 2.0 (1.0, 3.0.), 2.0 (2.0, 3.0) and 3.0 (2.0, 4.0) for the children in HS, PHS and the follow-up children in PHS, respectively. The DDS in HS was positively associated with LAZ at follow-up (β = 0.16; 95% CI: 0.01, 0.30; P = 0.03) after controlling for confounding factors. ICFI and DDS were not associated with mean LAZ, weightfor-height z-score and weight-for-age z-score within season. However, the odds of being stunted when having a DDS ≤ 2 was 2.3 times (95% CI: 1.10, 4.78; P = 0.03) higher compared to a DDS > 2 child in HS and 1.7 times (95% CI: 1.04, 2.71; P = 0.04) higher for the pooled sample of 6-12 months old children in HS and PHS. Conclusions: The DDS was found to be an indicator for child stunting during the Ethiopian harvest season. The DDS can be an appropriate tool to evaluate the association of child feeding practices with child growth irrespective of season. Inclusion of other dimensions in the construction of ICFI should be considered in future analysis as we found no association with growth.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Dietary Diversity Scorementioning

confidence: 98%

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Feeding practices and growth among young children during two seasons in rural Ethiopia

et al. 2017

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“…15 Previous studies in pastoral communities also reported low dietary diversity with dairy and cereals being the major food groups. 3,5,24,25 Similarly, such low levels of dietary diversity scores have been previously reported from different parts of Ethiopia: 2.2 by Arimond and Ruel, 26 2.2 by Beyene et al 27 and 2.1-2.3 by Wondafrash et al 28 Hirvonen 29 also compared dietary diversity in Ethiopia Abbreviations: RNI, recommended nutrient intake; MAR, mean nutrient adequacy ratio; NAR, nutrient adequacy ratio (%).…”

Section: Discussionmentioning

confidence: 66%

<p>Dietary Intake of Infant and Young Children and Assessment of Dietary Adequacy Indicators in a Pastoral Setting, Southern Ethiopia</p>

Megersa¹

2020

NDS

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Introduction: Pastoral system is undergoing rapid socioeconomic transformation and livelihood shifts that may facilitate dietary transitions. Understanding the feeding practices and dietary intake is vitally important for designing an intervention program that addresses the nutrition needs of children in pastoral areas where scarcity of dietary information exists. Methods: Community-based study of dietary intake and questionnaire survey was conducted in Borana pastoral system of southern Ethiopia. The study aimed at investigating the dietary intake of under-five children (n=538) and to assess how well dietary diversity score (DDS), milk and meal frequencies estimate the adequacy of nutrient intake under pastoral context. Recipes and ingredients used to prepare the foods were recorded, and the portion size was estimated to calculate the nutrient contents per 100 grams of the food items. Then, nutrient adequacy ratio (NAR) of a given nutrient and mean adequacy ratio (MAR) were calculated. Results: The study showed that children had a low level of DDS (2.7) and meal frequency (2.3), but had satisfactory milk frequency (4.3). About 31.2% of the children had met minimum meal frequency while only a few (11.7%) attained the minimum DDS. Dairy (99.8%) was the most consumed food item followed by cereals (83.6%) and legumes (53.5%). Thus, dairy contributed to a higher percentage (>85%) of calcium, vitamin A and Vitamin B2 requirements. Dairy marketing was found to have significant effects on dietary patterns i.e. has reduced milk frequency but associated with an increased number of meals per day. Overall, inadequate intakes (NAR < 66%) were observed for Vitamins A, B1, C, folic acid, and Iron. Assessment of dietary adequacy indicators showed that DDS had a greater ROC area (0.71) and better prediction of dietary quality than meal (0.62) and milk (0.50) frequencies, but did not differ from the average of milk and meal frequencies (0.64). Discussion: Diets of the study children were much below the WHO standards with dairy and cereals being the major component of child nutrition reflecting a typically low dietary diversity in pastoral areas. As a result, study subjects had insufficient intakes of several nutrients, implying the need for supplementing critical micronutrients. As dairy is the main staple and local commodity its marketing was found to significantly influence the dietary patterns of children. DDS was found to be the best indicator of dietary adequacy while the averaged frequencies of milk and meal also showed a promising result.

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Assessment of Undernutrition Among Children in 55 Low- and Middle-Income Countries Using Dietary and Anthropometric Measures

et al. 2021

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IMPORTANCE Evidence on the suitability of anthropometric failure (ie, stunting, underweight, and wasting) as a stand-alone measure of child undernutrition can inform global and national nutrition and health agendas. OBJECTIVE To provide a comprehensive estimate of the prevalence of child undernutrition by evaluating both dietary and anthropometric measures simultaneously across 55 low-and middleincome countries. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional study that used Demographic and Health Surveys program data from July 2009 to January 2019, to allocate children into dietary and anthropometric failure categories. Nationally representative household surveys were conducted in 55 low-and middle-income countries. Participants included children aged 6 to 23 months who were born singleton and had valid anthropometric measures as well as available 24-hour food intake recollection. Data analysis was conducted from August 23 to October 22, 2020. EXPOSURES Two factors were considered to allocate children into the respective categories. Dietary failure was based on the World Health Organization standards for minimum dietary diversity. Anthropometric failure was constructed using the World Health Organization child growth reference standard z score for stunted growth, muscle wasting, and less than average weight for age. MAIN OUTCOMES AND MEASURES Dietary and anthropometric failures were cross-tabulated, which yielded 4 potential outcomes: dietary failure only, anthropometric failure only, both failures, and neither failure. Total child populations for each category were extrapolated from United Nations population estimates. RESULTS Of the 162 589 children (median age [range], 14 months [6-23 months]; 83 467 boys [51.3%]; 78 894 Asian children [48.5%]) in our sample, 42.9% of children had dietary failure according to the standard World Health Organization definition without being identified as having anthropometric failures. In all, 34.7% had both failures, 42.9% had dietary failure only, 8.3% had anthropometric failure only, and 14.1% had neither failure. Dietary and anthropometric measures were discordant for 51.2% of children; these children had nutritional needs identified by only 1 of the 2 measures. Dietary failure doubled the proportion of children in need of dietary interventions compared with anthropometry alone (43%). A total of 45.3 million additional children who experienced undernutrition in these 55 countries were not captured through the evaluation of anthropometric failures only. These results were consistent across geographic regions. CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that the current standard of measuring child undernutrition by estimating the prevalence of anthropometric failure (continued) Key Points Question Is anthropometric failure an adequate stand-alone measure to estimate global child undernutrition, and how do estimates change when dietary measures are also taken into account? Findings In this cross-sectional study of 162 589 children (...

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Dietary diversity predicts dietary quality regardless of season in 6–12-month-old infants in south-west Ethiopia

Cited by 19 publications

References 17 publications

Feeding practices and growth among young children during two seasons in rural Ethiopia

Feeding practices and growth among young children during two seasons in rural Ethiopia

<p>Dietary Intake of Infant and Young Children and Assessment of Dietary Adequacy Indicators in a Pastoral Setting, Southern Ethiopia</p>

Assessment of Undernutrition Among Children in 55 Low- and Middle-Income Countries Using Dietary and Anthropometric Measures

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