Objective: Simple, cost-effective and convenient instruments like food groupbased scores are proposed to assess micronutrient adequacy of children in developing countries. We assessed the predictive ability and seasonal stability of a dietary diversity score (DDS) to indicate dietary quality of infants. Design: A 24 h dietary recall assessment was carried out on a sample of 320 and 312 breast-fed infants aged 6-12 months during harvest (HS) and pre-harvest (PHS) seasons, respectively, in Ethiopia. DDS was calculated based on seven food groups, while mean micronutrient density adequacy (MMDA) was calculated for eight micronutrients. Multiple linear regression models were used to assess the relationship between DDS and MMDA, and differences in nutrient intake between the two seasons. A receiver-operating characteristic curve analysis was performed to derive DDS cut-offs that maximized sensitivity and specificity of assessing dietary quality. Setting: The study was conducted in the catchment of the Gilgel Gibe Field Research Centre of Jimma University, south-west Ethiopia. Results: The mean (SD) DDS for HS and PHS was 2·1 (0·94) and 2·3 (1·1), respectively. The DDS was associated with MMDA (β = 0·045, P < 0·0001 in HS; β = 0·044, P < 0001 in PHS). A DDS of ≤2 food groups best predicted 'low' MMDA (<50 %) with 84 % and 92 % sensitivity, 36 % and 43 % specificity, and 47 % and 51 % correct classification for the HS and PHS, respectively. Conclusions: DDS is predictive of dietary quality of breast-fed infants. The study supports the use of DDS to indicate inadequate intakes of micronutrients by breast-fed infants in different seasons.
Keywords
Ethiopia Dietary diversity Micronutrient density adequacy Breast-fed infantsEthiopia has one of the highest rates of child malnutrition (1) . The nutritional status is influenced by many interrelated factors (2) . Among others, Ca, Zn, Fe, vitamin A and iodine deficiencies are common in Ethiopia, and have been attributed to low intake and low bioavailability (1,(3)(4)(5) . Moreover, the monotonous consumption of staple foods in complementary feeding fails to meet the daily requirements of infants and young children (6,7) . The assessment of nutritional status has been limited to anthropometry due to the time-and personnel-consuming nature of dietary assessments (8) . As a result, an intake assessment of nutrients, single food items or a combination of foods to predict the risk of one or more health-related problems has emerged as an alternative approach to actual quantification of nutrient intakes (9) .However, the problem of diagnostic ability of several dietary indices to predict health outcomes, dietary quality or nutritional status has not been resolved for some reasons (9) .The dietary diversity score (DDS) is a simple indicator of dietary diversity and is based on measuring the number of food groups consumed over a given reference period. A higher dietary diversity is associated with an adequate intake of essential micronutrients. The score has been shown to be ass...