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Verger EO, Eymard-Duvernay S, Bahya-Batinda D, Hanley-Cook GT, Argaw A, Becquey E, Diop L, Gelli A, Harris-Fry H, Kachwaha S, Kim SS, Nguyen PH, Saville NM, Tran LM, Zagré RR, Landais E, Savy M, Martin-Prevel Y, Lachat C. 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. Curr Dev Nutr 2024; 8:102053. [PMID: 38187987 PMCID: PMC10767136 DOI: 10.1016/j.cdnut.2023.102053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background 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. Objective 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. Methods 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. Results 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%). Conclusions 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.
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Affiliation(s)
- Eric O Verger
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | | | - Dang Bahya-Batinda
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Giles T. Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Loty Diop
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Aulo Gelli
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Helen Harris-Fry
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sunny S Kim
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | - Phuong Hong Nguyen
- International Food Policy Research Institute (IFPRI), Washington, DC, United States
| | | | | | - Rock R Zagré
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
| | - Edwige Landais
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Mathilde Savy
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Yves Martin-Prevel
- MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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