Defining a Dichotomous Indicator for Population-Level Assessment of Dietary Diversity Among Pregnant Adolescent Girls and Women: A Secondary Analysis of Quantitative 24-h Recalls from Rural Settings in Bangladesh, Burkina Faso, India, and Nepal

• Published in: Current developments in nutrition 2024-01, Vol.8 (1), p.102053-102053, Article 102053
• Main Authors: Verger, Eric O, Eymard-Duvernay, Sabrina, Bahya-Batinda, Dang, Hanley-Cook, Giles T., Argaw, Alemayehu, Becquey, Elodie, Diop, Loty, Gelli, Aulo, Harris-Fry, Helen, Kachwaha, Shivani, Kim, Sunny S, Nguyen, Phuong Hong, Saville, Naomi M, Tran, Lan Mai, Zagré, Rock R, Landais, Edwige, Savy, Mathilde, Martin-Prevel, Yves, Lachat, Carl
• Format: Article
• Language: English
• Subjects: Diet; dietary diversity; Evaluation; Food and Nutrition; Health aspects; indicator; Life Sciences; Methods; micronutrient adequacy; minimum dietary diversity for women; Nutrition surveys; Nutritional aspects; pregnant; Pregnant girls; Pregnant women; resource-poor settings; Rural women; Surveys
• ISSN: 2475-2991; 2475-2991
• DOI: 10.1016/j.cdnut.2023.102053

The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements. This study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15–49 y in LMICs. We used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60. In the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%). The WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15–49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.