Performance of individual dietary diversity score to identify malnutrition among patients living with HIV in Ethiopia

Foziya Mohammed Hussien,Kalkidan Hassen Abate,Zinet Abegaz Asfaw,Wondwosen Mebratu,Anissa Mohammed Hassen,Hamid Yimam Hassen,Tefera Chane Mekonnen,Aragaw Yimer Ahmed

doi:10.1038/s41598-021-98202-6

Foziya Mohammed Hussien, Kalkidan Hassen Abate + Show 6 more

Open Access

https://doi.org/10.1038/s41598-021-98202-6

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Abstract

There is a lack of uniformity in developing and validating indicators of nutritional status among People Living with Human Immunodeficiency Virus (PLHIV). Experiences from low and middle-income countries are scant, and differences in methodological and analytical approaches affect the comparability and generalizability of findings. Therefore, this study investigated the performance of individual diversity score (IDDS) as a proxy indicator of nutritional status among PLHIV. We conducted a facility-based cross-sectional study among 423 PLHIV who were under Antiretroviral Treatment (ART) at clinics in Bahir-Dar, Ethiopia. We collected data on sociodemographic, dietary, clinical, and anthropometric measures. Dietary intake was assessed using 24-Hour dietary recall. Body Mass Index (BMI) was calculated to assess the nutritional status of study subjects. The receiver operating characteristic (ROC) curve analysis was used to assess the ability of the IDDS and Minimum Dietary Diversity for Women (MDD-W) to detect poor nutritional status. Furthermore, sensitivity, specificity, Predictive Values (PPs), and Likelihood Ratios (LRs) were calculated at different cut-off points. IDDS showed good reliability with Cronbach’s Alpha of 0.76. The Area Under the Curve (AUC) of IDDS was 78.5 (95%CI 73.9–83.4). At the IDDS cut-off of 4, the sensitivity and specificity of IDDS to indicate nutritional status were 88.0% (95%CI 81.0–93.0) and 71.0% (95%CI 66.0–76.0), respectively. The AUC of MDD-W was 74.1%, and at the cut-off of 4 the sensitivity and specificity of MDD-W to indicate undernutrition were 73.0% and 72.0%, respectively. Both IDDS and MDD-W have good accuracy as a proxy indicator for measuring the nutritional status of PLHIV. In the prevention of undernutrition among PLHIV especially in a resource-limited setting, IDDS and MDD-W can be used to assess nutritional status.

Highlights

Abbreviations AIDS Acquired immune deficiency syndrome Antiretroviral Treatment (ART) Anti-Retroviral Therapy Area Under the Curve (AUC) Area Under Receiver operating characteristic (ROC) Curve BMI Body Mass Index CI Confidence Interval HIV Human Immune Deficiency Virus individual diversity score (IDDS) Individual Dietary Diversity Score Likelihood Ratios (LRs)− Negative Likelihood Ratio LR+ Positive Likelihood Ratio NPV Negative Predictive Value MPA Mean Probability of Adequacy People Living with Human Immunodeficiency Virus (PLHIV) People Living With Human Immune deficiency Virus
There is no international consensus on the number and type of food groups to include in the IDDS, and consistent cutoffs to determine the adequacy of dietary diversity[7,15]
Its predictive power was good to classify the nutritional status of PLHIV

Summary

Introduction

Abbreviations AIDS Acquired immune deficiency syndrome ART Anti-Retroviral Therapy AUC Area Under ROC Curve BMI Body Mass Index CI Confidence Interval HIV Human Immune Deficiency Virus IDDS Individual Dietary Diversity Score LR− Negative Likelihood Ratio LR+ Positive Likelihood Ratio NPV Negative Predictive Value MPA Mean Probability of Adequacy PLHIV People Living With Human Immune deficiency Virus. Accurate and consistent measurement of dietary intake and patterns of eating behavior is necessary to monitor and evaluate the effectiveness of public health interventions aimed at improving diet and reduce malnutrition.[13]. IDDS is an indicator for assessing the quality of an individual’s dietary h abits[7,14] It is more of a proxy of the nutrient (mainly micronutrient) adequacy of the diet of an individual[7]. Tool validation is of particular importance in any dietary assessment m ethod[13,16]

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