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

• Published in: Current developments in nutrition Vol. 1; no. 12; p. cdn.117.001701
• Main Authors: Martin-Prevel, Yves, Arimond, Mary, Allemand, Pauline, Wiesmann, Doris, Ballard, Terri J, Deitchler, Megan, Dop, Marie Claude, Kennedy, Gina, Lartey, Anna, Lee, Warren TK, Moursi, Mourad
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017; Oxford University Press; American Society for Nutrition
• Subjects: developing countries; diet quality; dietary diversity; Food; Food and Nutrition; food groups; indicator; Life Sciences; nutrition-sensitive interventions; Original Research; resource-poor settings; Santé publique et épidémiologie; women of reproductive age; indicator; Ug2; NPNL; WRA; food groups; FGI; MDD-W; resource-poor settings; women of reproductive age; BF1; nutrition-sensitive interventions; BF2; Phi; PA; WDDP; developing countries; Mali; diet quality; EAR; Moz; Ban2; Ban1; Ug1; dietary diversity
• ISSN: 2475-2991; 2475-2991
• DOI: 10.3945/cdn.117.001701

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