Abstract
Dietary quality contributes to an individual’s nutrition and health status, with a high-quality diet providing the right nutrients in the right amounts for health and well-being. Attainment of a high-quality diet is particularly problematic among poor populations in low-income countries where diets are dominated by starchy staple foods, and nutrient-dense animal source foods, fruits, and vegetables are often unavailable or unaffordable. The measurement of dietary quality is also more difficult in these contexts, where a lack of resources and research capacity makes the collection and analysis of detailed quantitative dietary data for research or program planning difficult. Dietary diversity (DD), the number of foods or food groups consumed, is a key dimension of dietary quality, with diverse diets increasing the likelihood of adequate intake of essential nutrients. This chapter updates a 2003 review of DD indicators (J Am Diet Assoc 96:785–791, 1996) and summarizes new evidence regarding their potential use as a proxy for dietary quality in developing country contexts. The review concludes that new evidence confirms that DD indicators are useful, simple indicators for assessing diet quality among children and adults in developing countries.
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Notes
- 1.
Validation studies are defined here as studies that test the association and predictive power of a dietary diversity indicator against a gold standard, which in this case is defined as a quantitative measure of micronutrient adequacy (or density in young children) of the diet. In other words, studies are considered “validation studies” if they test whether or not DD indicators are associated with—and how well they or predict—micronutrient density or adequacy of the diet. Association studies, on the other hand, are those that look at the association between DD indicators and outcomes such as anthropometric indicators in children or adults. These latter studies are not considered validation studies because they do not test DD indicators against a gold standard measure of the construct they are supposed to reflect (i.e., micronutrient adequacy/density of the diet).
Abbreviations
- BFP:
-
Body fat percentage
- BMI:
-
Body Mass Index
- CFI:
-
Complementary Feeding Index
- DD:
-
Dietary diversity
- DDS:
-
Dietary diversity score
- DHS:
-
Demographic and health surveys
- DQ:
-
Dietary quality
- EAR:
-
Estimated average requirement
- FAO:
-
Food and Agriculture Organization
- FFQ:
-
Food frequency questionnaire
- FGI:
-
Food group indicator
- FVS:
-
Food variety score
- HAZ:
-
Height-for-age Z-score
- LAZ:
-
Length-for-age Z-score
- MAR:
-
Mean adequacy ratio
- MMDA:
-
Mean micronutrient density adequacy
- MPA:
-
Mean probability of adequacy
- MUAC:
-
Mid upper arm circumference
- NAR:
-
Nutrient adequacy ratio
- NDA:
-
Nutrient density adequacy
- NPA:
-
Nutrient probability of adequacy
- NPNL:
-
Non-pregnant non-lactating
- qFGI:
-
Qualitative food group indicators
- QFGI:
-
Quantitative food group indicators
- RNI:
-
Recommended nutrient intake
- ROC:
-
Receiver operating characteristic
- Se/Spe:
-
Sensitivity/specificity
- WAZ:
-
Weight-for-age Z-score
- WHO:
-
World Health Organization
- WHZ:
-
Weight-for-height Z-score
- WLZ:
-
Weight-for-length Z-score
- WR:
-
Weighed record
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Ruel, M.T., Harris, J., Cunningham, K. (2013). Diet Quality in Developing Countries. In: Preedy, V., Hunter, LA., Patel, V. (eds) Diet Quality. Nutrition and Health. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7315-2_18
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