Mapping Definitions, Measures, and Methodologies for Assessing Dietary Diversity in the Nutrition Literature: Results of a Systematic Scoping Review.

Dietary variety and diversity are recommended in dietary guidelines, but their association with BMI in US preschool-aged children is unknown. This study examined predictors of dietary variety and diversity and their association with child BMI z score (BMIz). Primary caregivers responded to a food frequency questionnaire. Child anthropometry was obtained concurrently (n = 340) and prospectively (n = 264). Dietary variety scores and dietary diversity scores were computed. Multivariable linear regression was used to model predictors of these scores and their association with BMIz concurrently and BMIz change per year prospectively. The sample was 49.4% boys; 69.4% of the primary caregivers were non-Hispanic white and 46.2% had a high school education or less. Girls and older children had greater Fruit and Vegetable Variety (gender: P = .03, age: P < .001), Healthy Foods Variety (P = .02, P < .001), and Dietary Diversity (P = .04, P = .03) scores. Older children also had greater scores for Overall Variety (P < .001) and Moderation Foods (eg, high-fat, high-sugar foods recommended to be consumed in moderation) (P < .001). Having a non-Hispanic white primary caregiver (versus not) was associated with lower Dietary Diversity (P = .01). Greater Healthy Variety, Overall Variety, and Dietary Diversity were associated with greater annual increases in BMIz prospectively (β[SE] = 0.009 [0.004], P = .04; β[SE] = 0.007 [0.003], P = .02; β[SE] = 0.003 [0.001], P = .02, respectively), adjusted for energy intake. Greater dietary variety and diversity were prospectively associated with higher BMIz. Targeting dietary variety and diversity as an obesity prevention strategy in children requires careful consideration.

Dietary diversity has been linked to insulin resistance; however, studies are inconsistent on whether dietary diversity protects against metabolic-related outcomes. We aimed to comprehensively assess metabolic-related outcomes of greater diversity across the diet and within major food groups. A systematic search of peer-reviewed literature was done in bibliographic databases (Medline, Scopus, and Web of Science) for longitudinal studies that reported on original research. Data extraction and quality appraisal used predefined criteria; reported findings were synthesized through a narrative approach. Fourteen studies were identified as eligible. Greater dietary diversity across major food groups, and diversity within fruits and/or vegetables, was associated with reduced risk of type 2 diabetes (T2D). Effects varied based on exposure definition and adjustment for known confounders. While diversity of less healthy foods was associated with greater adiposity, diversity of all foods and healthy foods was associated with reduced incidence of depression and cognitive decline. Evidence supports the protective effect of dietary diversity against cognitive decline and T2D. The association between dietary diversity and adiposity may be dependent on the healthiness of foods. Public health efforts to prevent metabolic-related diseases should include an emphasis on a varied diet as a healthy eating strategy.

Women of reproductive age (WRA) are mostly vulnerable to low dietary diversity and micronutrient malnutrition due to their reproductive role. There is, however, limited data on the current situation in Kericho County. This study was aimed at determining the dietary diversity and micronutrient adequacy among women of reproductive age from kitchen gardening households in Kericho County. A cross-sectional study involving 193 WRA (15-49 years) was conducted in September and October, 2018, in Kericho County. A semi-structured questionnaire was used to collect data on sociodemographic and socioeconomic characteristics, and kitchen gardening. Minimum Dietary Diversity-Women (MDD-W), 24-hour dietary recall and Food Frequency Questionnaires were used on dietary intake and diversity data. All the respondents consumed starchy staples with a high proportion consuming dairy (99.5%) and dark green leafy vegetables (92.2%) whereas nuts and seeds were the least consumed (6.7%). The mean Dietary diversity score (DDS) was 5.3±1.4 with 72% of women consuming at least five groups out of ten recommended by food and agriculture organization (FAO) and FHI 360. Kitchen gardens’ size and number of crops grown had a positive significant contribution to dietary diversity (p=0.000).The mean adequacy ratio (MAR) for Vitamin A, iron and zinc was obtained as 89.9% with Vitamin A nutrient adequacy ratio (NAR) being the lowest (46.35%). A positive association was obtained between NAR for Vitamin A(r=0.499), iron (r=0.528) and zinc (r=0.569), and dietary diversity scores. A more diversified diet increased the chances of micronutrient adequacy. Slightly less than three quarters of women were micronutrient adequate due to attainment of recommended food groups. Hence, majority of WRA in Kericho County meet the recommended dietary diversity and micronutrient adequacy except for Vitamin A. There’s need to encourage households to dedicate larger share of their lands to kitchen gardening and have a diversity in their gardens and diet. Keywords: Minimum Dietary Diversity-Women, Nutrient Adequacy Ratio, Mean Adequacy Ratio, Micronutrient Adequacy.

Adolescents in low- and middle-income countries, such as Nigeria, are at increased risk of malnutrition, especially obesity, but there is limited data describing the risk. We assessed this risk by examining the nutritional status and associated factors such as dietary habits, dietary diversity, nutritional knowledge and sociodemographic characteristics among adolescents in Lagos, Nigeria. A descriptive cross-sectional study in which 682 adolescents were selected from their communities using a multistage sampling technique. Dietary habits were assessed using a food frequency questionnaire, and dietary diversity was assessed through nonquantifiable 24-h diet recall. Anthropometric measurements were taken to determine nutritional status. Data were analyzed using Epi-Info software version 7.2.3.1. Nutritional status was evaluated using WHO AnthroPlus software. Chi-square was used to test for an association between categorical variables, and P values ≤0.05 were considered statistically significant. The mean age of the adolescents was 13.6 ± 2.3 years, and only 47.4% of them had good nutritional knowledge. Dietary habits were poor and dietary diversity was low. The prevalence of overweight and obesity was 13.4% and 7.0%. Eating dinner, dieting to control weight and daily consumption of foods outside the home were associated with overweight and obesity (P < 0.05). Dietary habits and diversity of the adolescents were poor, while overweight and obesity were high. Eating dinner and daily consumption of foods outside the home were factors associated with being overweight and obesity. Our findings emphasize the critical need for adolescent nutrition programs that address weight control, especially among those who eat outside their homes.

Background and Aim:Inadequate nutrition during fetal development resulting from poor dietary habits leads to reprogramming within fetal tissues and poses as a risk factor for non-communicable diseases in later life. This study was conducted to determine the dietary habits, diversity, and predictors among pregnant women in Lagos, Nigeria.Methods:A descriptive cross-sectional study was conducted using a structured interviewer-administered questionnaire to obtain data from pregnant women attending primary health care centers in Lagos, Nigeria. A multistage sampling method was used to select 350 pregnant women. A food frequency questionnaire was used to assess the dietary habits while dietary diversity was measured using non-quantifiable 24-hour recall. Data were analyzed using Epi-Info version 7.2 computer software. Chi-square and t-test were used to test for associations and P value < 0.05 was considered to be statistically significant.Results:Only 16.7% of respondents consumed five servings of fruits and vegetables daily while the rice was the most frequent meal taken (45.4%). Meat was the commonest animal protein (20.3%) and only 30.8% had a high dietary diversity score (DDS). High DDS was significantly associated with parity of 1–3, living in a duplex or detached house, completion of at least secondary school education, and highly skilled professionals.Conclusion:Healthy dietary habits and high DDS were low and associated with low parity and higher socio-economic status. Nutrition intervention that encourages higher dietary diversity is needed especially among women of higher parity and lower socioeconomic status in Lagos.

BackgroundIn Northern Uganda, 21 and 52.4% of children under five are underweight and stunted, respectively while 32.9% of pregnant women are anemic. This demographic situation suggests among other issues, a lack of dietary diversity among households. Good nutrition practices that confer dietary quality such as dietary diversity are known to depend on nutrition knowledge and attitude and are shaped by sociodemographic and cultural factors. However, there is a paucity of empirical evidence to support this assertion for the variably malnourished population of Northern Uganda.MethodsA cross-sectional nutrition survey was conducted among 364 household caregivers (182 from two locations in Northern Uganda; Gulu District (the rural) and Gulu City (the urban), selected through a multistage sampling approach. The aim was to determine the status of dietary diversity and its associated factors between rural and urban households of Northern Uganda. The household dietary diversity questionnaire and the food frequency questionnaire on a 7-day reference period were used to collect data on household dietary diversity whereas multiple choice questions and the five points Likert Scale were used to determine knowledge and attitude toward dietary diversity. Consumption of ≤ 5 food groups were regarded as low in dietary diversity, 6–8 food groups as medium and ≥ 9 as high dietary diversity score using the FAO 12 food groups. An Independent two-sample t-test was used to differentiate the status of dietary diversity between the urban and rural areas. The Pearson Chi-square Test was used to determine the status of knowledge and attitude while Poisson regression was used to predict dietary diversity based on caregivers’ nutritional knowledge and attitude and their associated factors.ResultsThe 7-day dietary recall period revealed that dietary diversity was 22% higher in urban (Gulu City) than in the rural area (Gulu District) with rural and urban households achieving medium (score of 8.76 ± 1.37) and high (score of 9.57 ± 1.44) dietary diversity status, respectively. Diets in both locations were dominated by starchy cereals and tubers while animal-source foods and fruits and vegetables were the least consumed. A higher proportion (51.65%) of urban respondents had good nutrition knowledge toward dietary diversity compared to their rural counterparts (23.08%) and a significantly higher proportion (87.91%) of the former exhibited positive attitude towards dietary diversity than the rural counterparts (72.53%). Application of the Poisson regression shows that nutritional knowledge was a positive predictor of dietary diversity in the rural (β = 0.114; ρ = 0.000) than in the urban areas (β = -0.008; ρ = 0.551). Caregivers attitude had no significant effect across locations. In terms of associated factors, marital status is a positive predictor of dietary diversity in the urban (β = 1.700; ρ = 0.001) than the other location (β = -2.541; ρ = 0.008). Whereas education level of household caregiver and household food expenditure show negative effects across the two locations, the educational level of the household head is an outlier as it positively predicted dietary diversity in the rural (β = 0.003; ρ = 0.002) when compared to urban area (β = -0.002; ρ = -0.011).ConclusionRural households in Northern Uganda have medium-level dietary diversity with urban households having high dietary diversity. Diets in both locations are dominated by starchy cereals and roots and tubers. The urban–rural food divide can be harmonized through nutrition education and outreach, specifically focusing on the FAO 12 food groups. Attitude toward consumption of fruits and vegetables which are seasonally abundant would improve dietary diversity and nutritional outcomes in the study area.

BackgroundEarly childhood caries (ECC) is a global public health crisis affecting large populations of children, although the prevalence in suburban Nigeria is low. The role of dietary diversity in this context for ECC prevention remains unexplored. This study aimed to assess the associations between dietary diversity, food groups, and the prevalence and severity of ECC in Ile-Ife, Nigeria.MethodsThis was a school-based cross-sectional survey of children aged 36–71 months conducted in Ile-Ife, Nigeria, from September 2021 to September 2022, with participants randomly recruited from public and private nursery and primary schools. Information was collected on the independent variables (dietary intake and diversity assessed using a 24-hour recall and food frequency questionnaire), the dependent variables (dmft score), and the confounding variables (oral hygiene status, age, sex, and socio-economic status). Multivariable logistic regression was used to identify associations between the dependent and independent variables after adjusting for confounders.ResultsThe study recruited 430 children, of whom 61 (14.2%) had ECC and 19 (4.4%) had severe ECC. The mean dmft was 0.42 ± 1.3SD. High dietary consumptions were fats and oils (100%), beverages, spices, and condiments (100%), vegetables (96.3%), cereals (92.8%), and sweets/snacks (92.3%), while low-consumption items were eggs (37.2%), meat (50.5%), fish (54.7%), and dairy products (54.9%). Frequent consumption of fruits was associated with a significantly lower risk of ECC (AOR: 0.484; 95% CI: 0.261–0.900; p = 0.022). No significant associations were found between the overall dietary diversity score and ECC severity.ConclusionPromoting fruit consumption in early childhood diets may have a protective role against ECC and should be integrated into oral health education for parents.

Diet diversity in pregnancy and early allergic manifestations in the offspring.

ObjectiveTo identify dietary diversity and its associated factors among lactating women in the Debub Bench district. MethodsCross-sectional study design was conducted among 836 lactating women from January 1st to March 31st, 2019, in Debub Bench district. The outcome variable of the study was determined based on the proportion of lactating mothers who fed less than five major food groups to mothers who fed more than five major food groups out of nine (9) food groups. Lactating mothers who fed less than five of the major food groups were categorized under unacceptable dietary diversity. Data were first collected through face-to-face interviews by validated structured questionerers and then entered in Epi-data version 4.6.0.2 software. A bivariate and multivariate logistic regression analysis were later conducted using IBM SPSS version 26 software. During the analysis, multicollinearity was check by using the tolerance test and variance inflation factors (VIF), Hosmer-Lemeshow goodness of fit test was used to see model fitness, and adjusted odds ratios and their 95% confidence interval at P values ≤0.05 were considered to determine statistically significant factors. ResultA total of 836 lactating mothers had participated in the study. The response rate was 91.26%. The mean age of the participants was 29 years (SD ± 6.7). The study found that the magnitude of unacceptable dietary diversity score was 72.4% (95% CI: 69.5–75.5). The study also found that factors such as nutrition information (OR = 4, 95% CI: 2.64–6.08), absence of garden (OR = 2.35, 95% CI: 1.19–4.61), absence of latrine (OR = 6.86, 95% CI: 3.26–14.56) and household food insecurity (OR = 5.23, 95% CI: 3.64–7.46) were significantly associated with unacceptable dietary diversity. ConclusionThe finding of this study showed that information about nutrition, absence of latrine, absence of garden, and household food insecurity were significantly associated with dietary diversity. Based on the finding of the study, the following recommendations are made. First, strategies and programs targeted towards promoting dietary diversity and good health among lactating women should be made at all levels. Second, lactating mothers should be adequately provided with nutritional information. Three, mothers should be empowered to alleviate household food insecurity by leveraging their premises for gardening diversified and nutritious vegetables.

Adequate nutrition is an important factor for health and well-being of the mother and child during and after pregnancy. However, studies on the influence of the Nigeria’s national dietary food guidelines on health and nutritional status of pregnant women, especially, in poor-settings are sparse. The study assessed knowledge, attitude and practice of Food-Based Dietary Guidelines (FBDG) among pregnant women in urban slum of Lagos state. A total of 430 consenting pregnant women attending five selected Primary Health Care Centres in AjeromiIfelodun Local Government Area of Lagos State volunteered for this cross-sectional study. A pretested, intervieweradministered questionnaire was used as the survey instrument. Data was analyzed using descriptive and inferential statistics. The results of study showed that, the mean age of the respondents was 27.9 ± 5.2 years. The respondents were mostly married (82.2%), with secondary level education (58.0%), unemployed (61.6%) and with an estimated monthly income of approximately 33 American dollars per household (42.2%). A majority (95.1%) of the respondents have had advice on nutrition during pregnancy, obtained through antenatal clinic attendance (93.3%). Rates on adequate knowledge and positive attitude towards FBDG were 55.8% and 61.2% respectively. Rates for high, medium and low dietary diversity levels were 57.7%, 33.5%, and 8.8%. There was a significant association between level of dietary diversity and employment status (p<0.05). Less than half (43.5%) of the respondents had good practice of the FBDG. Financial constraints (68.1%) and cultural belief and norms (61.5%) were major factors limiting adequate nutrition during pregnancy and compliance with dietary guidelines. The study concluded that, Nigerian pregnant women living in urban slum of Lagos state have above average knowledge of the nutrition information and positive attitude towards dietary guideline, as contained in the Nigerian food based dietary guideline. Unemployed pregnant women had a higher dietary diversity compared with their employed counterparts. Financial constraint and cultural belief and norms were factors that act against compliance to dietary guidelines. It is therefore, recommended that national food based dietary guidelines education be incorporated into routine of antenatal care in Nigeria. Some practical suggestions to ensure the implementation of the Food Based Dietary guidelines include providing Healthcare workers at the Antenatal clinics training and resource materials to educate pregnant women attending antenatal clinics on the Food Based Dietary Guidelines. Also, every pregnant woman should get a free copy of a pictorial version of the Food Based Dietary Guideline.

BackgroundDiet is a key modifiable risk factor for multiple chronic conditions, including type 2 diabetes (T2D). Consuming a range of foods from the five major food groups is advocated as critical to healthy eating, but the association of diversity across major food groups with T2D is not clear and the relationship of within-food-group diversity is unknown. In addition, there is a growing price gap between more and less healthy foods, which may limit the uptake of varied diets. The current study had two aims: first, to examine the association of reported diversity of intake of food groups as well as their subtypes with risk of developing T2D, and second, to estimate the monetary cost associated with dietary diversity.Methods and FindingsA prospective study of 23,238 participants in the population-based EPIC-Norfolk cohort completed a baseline Food Frequency Questionnaire in 1993–1997 and were followed up for a median of 10 y. We derived a total diet diversity score and additional scores for diversity within each food group (dairy products, fruits, vegetables, meat and alternatives, and grains). We used multivariable Cox regression analyses for incident diabetes (892 new cases), and multivariable linear regression for diet cost. Greater total diet diversity was associated with 30% lower risk of developing T2D (Hazard ratio [HR] 0.70 [95% CI 0.51 to 0.95]) comparing diets comprising all five food groups to those with three or fewer, adjusting for confounders including obesity and socioeconomic status. In analyses of diversity within each food group, greater diversity in dairy products (HR 0.61 [0.45 to 0.81]), fruits (HR 0.69 [0.52 to 0.90]), and vegetables (HR 0.67 [0.52 to 0.87]) were each associated with lower incident diabetes. The cost of consuming a diet covering all 5 food groups was 18% higher (£4.15/day [4.14 to 4.16]) than one comprising three or fewer groups. Key limitations are the self-reported dietary data and the binary scoring approach whereby some food groups contained both healthy and less healthy food items.ConclusionsA diet characterized by regular consumption of all five food groups and by greater variety of dairy, fruit, and vegetable subtypes, appears important for a reduced risk of diabetes. However, such a diet is more expensive. Public health efforts to prevent diabetes should include food price policies to promote healthier, more varied diets.

BackgroundHigh gluten and low dietary fiber in pregnancy intake is associated with an increased risk of celiac disease (CeD) in the child. Early life higher dietary quality is suggested to reduce the subsequent risk of CeD. ObjectivesThe aim was to investigate associations of pregnancy dietary quality and diversity with child risk of CeD. MethodsIn The Norwegian Mother, Father and Child Cohort Study, 85,122 mother-child pairs had available data from a validated pregnancy food frequency questionnaire. Pregnancy dietary quality and diversity were estimated by a Pregnancy Healthy Eating Index [mean 99.3, standard deviation (SD) 9.9, range 48.8–128.3], and a Diet Diversity Score (mean 7.0, SD 1.0, range 1.6–9.8), respectively. Child CeD was captured by ≥2 diagnostic codes in the Norwegian Patient Registry. Logistic regression was used to estimate associations between pregnancy dietary quality, diversity and child CeD, adjusted for socioeconomic factors, and parents CeD [adjusted odds ratio (aOR), 95% confidence intervals (CI)]. CeD-susceptible human leukocyte antigen haplotypes (DQ2/DQ8) were present in 30,718 (45.5%). ResultsUp to mean age 16.0 (SD 1.8, 12.4–19.8) y, 1363 (1.6%) children were diagnosed with CeD. Lower as well as higher pregnancy dietary quality associated with a reduced risk of CeD in the child (<5th percentile aOR = 0.67, 95% CI: 0.48, 0.93, >95th percentile aOR = 0.71, 95% CI: 0.52, 0.98, respectively, nonlinear squared term P = 0.011). Analyses on genetically susceptible children, adjustments for pregnancy iron supplementation, gluten, and dietary fiber intake, and child early life dietary quality, gluten intake and iron supplementation, supported the finding. Pregnancy dietary diversity was not associated with child CeD (aOR = 1.00, 95% CI: 0.94, 1.07/score). ConclusionsIn this population-based study, lower as well as higher pregnancy dietary quality associated with a reduced risk of CeD diagnosis in the child. In contrast, no such association was observed with maternal dietary diversity.

Association of dietary diversity and weight change with cognitive impairment among Chinese elderly: A prospective national cohort study

In this study, we evaluate diet diversity, diet composition, and risk of colon cancer in an incident population-based study of 1,993 cases and 2,410 controls in the Kaiser Permanente Medical Care Program of Northern California, eight counties in Utah, and the Twin Cities area of Minnesota (United States). Ninety-one and one-half percent of the population were non-Hispanic White. Dietary intake was obtained using an adaptation of the CARDIA diet-history questionnaire. Diet diversity was defined as the number of unique food items reported; diversity also was explored within six major food groups. Composition of the diet was described by estimating the proportion of total number of food items contributed by major food groups. Younger individuals, higher educated individuals, and those who lived in larger households reported eating the most diverse diet. Total diet diversity was not associated with colon cancer. However, eating a diet with greater diversity of meats, poultry, fish, and eggs, was associated with a 50 percent increase in risk among all men (95 percent confidence interval [CI] = 1.1-2.0; P trend = 0.01), with slightly stronger associations for younger men and men with distal tumors. A diet with a greater number of refined grain products also was associated with increased risk among men (odds ratio [OR] = 1.7, CI = 1.3-2.3). Women who ate a diet with a more diverse pattern of vegetables were at approximately a 20 percent lower risk than women who had the least diverse diet in vegetables. Assessment of diet composition showed that men who consumed a large proportion of their food items from meat, fish, poultry, and eggs were at an increased risk, with the most marked association being for distal tumors (OR = 1.7, CI = 1.2-2.5). Women who consumed the largest percentage of their food items in the form of plant foods (fruits, vegetables, or whole grains) were at a reduced risk of developing colon cancer (OR = 0.7, CI = 0.5-1.0).

This study assessed dietary diversity, its relation to micronutrient intake and variability between age-groups among women 19–69 years from informal settlements of Gauteng province, South Africa. The study was cross-sectional, involving 260 women. Dietary intake was obtained from 24-hour recall data, and Dietary Diversity Score (DDS) from Food Frequency Questionnaire, calculated based on 9 food groups and 80 foods. Intake of eleven micronutrients was assessed as Nutrient Adequacy Ratios (NAR) and Mean Adequacy Ratios (MAR), using Estimated Average Requirements and Adequate Intakes of these micronutrients, following Institute of Medicine recommendations. On average, 26 foods and 7 food groups were consumed. There was a strong significantly positive relationship (p<0.001) between the NAR of respective micronutrients (as well as MAR) with the DDS, the relationship was negative with food variety and diversity within food groups; except for vitamin C. Age-group comparisons revealed the older age groups (36-years and older) being at-risk of low micronutrient intake; particularly in calcium, vitamins C and A. In conclusion, dietary diversity was above reference, there was a strong relationship between DDS and micronutrient intake, and there is a significant variation in intake between age-groups, with women 36-years and older being more at-risk of low micronutrient intake. Key words: Dietary diversity, informal settlements, micronutrients, nutrient adequacy, nutrition education.