Does the high dietary diversity score predict dietary micronutrients adequacy in children under 5 years old? A systematic review

Early-Life Diet Diversity and the Subsequent Risk of Inflammatory Bowel Disease: Findings From Two Scandinavian Birth Cohorts

BACKGROUND

Diet diversity in early childhood promotes microbial diversity, influences the developing immune system, and has been linked to a reduced risk of immune-mediated diseases. This study aimed to determine the association between childhood diet diversity and later inflammatory bowel disease (IBD), for which data are limited.

METHODS

Questionnaire data from the population-based birth cohorts All Babies in Southeast Sweden (ABIS) and the Norwegian Mother, Father, and Child Cohort (MoBa), including participants from Southeast Sweden and Norway, were used to estimate a diet diversity score at ages 1 and 3 years. This score represents the diversity of intakes across 5 food groups comprising 11 subgroups. A higher score signifies higher diet diversity. We used linked health registry data to identify IBD diagnoses up to the year 2021. Cox regression and random-effect models were used to estimate pooled hazard ratios (aHRs) adjusted for sociodemographics, breastfeeding, and early-life antibiotic use.

RESULTS

Among 81 272 children with 1 304 325 person-years of follow-up, 307 developed IBD. Diet diversity at ages 1 and 3 years was in pooled analyses not associated with later IBD (per one-unit increase, aHR = 0.96 [95% CI = 0.81-1.14] and aHR = 0.96 [95% CI = 0.83-1.11]). In MoBa, but not ABIS, a higher diet diversity at 1 and 3 years of age was inversely associated with ulcerative colitis (UC) (per one-unit increase, aHR = 0.78 [95% CI = 0.66-0.94] and aHR = 0.78 [95% CI = 0.65-0.95]). Still, pooled aHRs for UC as well as Crohn's disease approximated one.

CONCLUSIONS

In this prospective study of 2 Scandinavian birth cohorts, no association was observed between early-life diet diversity and the subsequent risk of IBD.

Food poverty among children aged 6-59 months in Brazil: results from the Brazilian National Survey on Child Nutrition (ENANI-2019)

OBJECTIVE

To describe the prevalence of food poverty according to dimensions of socio-economic inequality and the food groups consumed by Brazilian children.

DESIGN

Dietary data from a structured qualitative questionnaire collected by the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The new UNICEF indicator classified children who consumed 3-4 and <3 out of the eight food groups as living in moderate and severe food poverty, respectively. The prevalence of consumption of each food group and ultra-processed foods (UPF) was estimated by level of food poverty according to age categories (6-23; 24-59 months). The most frequent combinations of food groups consumed by children living in severe food poverty were calculated. Prevalence of levels of food poverty were explored according to socio-economic variables.

SETTING

123 municipalities of the five Brazilian macro-regions.

PARTICIPANTS

12 582 children aged 6-59 months.

RESULTS

The prevalence of moderate and severe food poverty was 32·5 % (95 % CI 30·1, 34·9) and 6·0 % (95 % CI 5·0, 6·9), respectively. Children whose mother/caregiver had lower education (<8 years) and income levels (per capita minimum wage <¼) had the highest severe food poverty prevalence of 8·3 % (95 % CI 6·2, 10·4) and 7·5 % (95 % CI 5·6, 9·4), respectively. The most consumed food groups among children living in food poverty in all age categories were 'dairy products', 'grains, roots, tubers, and plantains' and 'ultra-processed foods'.

CONCLUSION

Food poverty prevalence was high among Brazilian children. A significant occurrence of milk consumption associated with grains and a considerable prevalence of UPF consumption were found among those living in severe food poverty.

Dietary Diversity and Its Association with Diet Quality and Health Status of European Children, Adolescents, and Adults: Results from the I.Family Study

Dietary diversity (DD) plays a crucial role in fostering high-quality diets, but its association with health outcomes, particularly body adiposity and non-communicable diseases (NCDs), is inconsistent. This may be due to a lack of a standardized method for estimating DD. Our study investigates the association between two DD indices, namely the dietary diversity score (DDS) and food variety score (FVS), and anthropometric measures, biochemical parameters, and diet quality in a large population sample from the I.Family study across research centers in eight European countries. In our cross-sectional analysis of 3035 participants, DDSs varied among countries, with a higher prevalence in the third DDS tertile among those with higher education. DDS showed a positive association with diet quality across all age groups. Higher DDS tertile individuals showed increased fiber, fruit, and vegetable intake, greater meal frequency, and lower ultra-processed food consumption. No relevant biochemical differences were observed across DDS tertiles, and a higher DDS was associated with lower overweight/obesity prevalence only in adults. No significant associations were found with FVS. Our findings emphasize the need to consider food groups for a more accurate estimation of diet quality. This aligns with studies suggesting DDS alone is not an independent risk factor for obesity in children and adolescents. Public health programs should prioritize food diversity to promote improved nutrition and overall well-being in communities.

Maternal Factors Associated with Dietary Diversity Scores of Children aged 6-23 Months in Kwale County, Kenya

Background

Dietary Diversity (DD) is an important component of Infant and Young Child Nutrition (IYCN). Globally, it is recommended that children aged 6-23 months be fed on diverse diets as a public health measure in curbing malnutrition. In Kenya, stunting rates among children below the age of five years is 26% and diversifying of diets is still sub-optimal. The study sought to assess maternal factors associated with dietary diversity scores among children aged 6-23 months in Kwale County, where stunting stands at 29%.

Methods

A cross sectional study design was adopted and a random sample of 244 mothers with children aged 6-23 months, residing in locations under Health and Demographic System Surveillance (HDSS) program participated in the study.

Results

Mothers aged 17-68 years were interviewed. Children's DD scores ranged from 0 to 5 with a mean of 2.2±0.9, only 8.2% of the children met the Minimum Dietary Diversity score (MDDs) of 4 food groups or more in a day. A bivariate regression analysis to determine factors associated with children's dietary diversity scores showed significant positive relationship with mother's educational level (r=0.186, P<.000, α=.01), household wealth index (r=0.163, P<.000, α=.01) and the child's age (r=0.396, P<.004, α=.01).

Conclusion

The study concludes that mothers' level of education, households' wealth index and child's age are factors associated with dietary diversity scores of children. Higher dietary diverse scores were observed among older children in the study age categories, from wealthy families and under care of mothers with higher education levels. In the study area however, only 8.2% of children met the minimum dietary diversity score necessitating targeted nutrition education of mothers and implementation of economic development initiatives to boost availability and consumption of diverse diets. A consideration of child age specific interventions will also address nutritional needs and preferences at different stages.

How is food variety conceptualised and measured as a diet quality indicator in developed settings? Protocol for a systematic scoping review

OBJECTIVES

Dietary diversity (DD) is a pillar of healthy eating guidance and can be used to assess diet quality. Despite being an established nutrition concept, many inconsistencies in its definition and measurement exist and meanings vary across the development spectrum. This protocol outlines a research trajectory, whereby a scoping review will be undertaken to illustrate and map the methodological approaches that have been utilised to measure diversity as a marker of diet quality in the general population. It seeks to determine the most common and less used methodological approaches to measure DD in the diet of healthy adults.

METHODS AND ANALYSIS

Scoping review of peer-reviewed and grey literature from five bibliographic databases, supplemented by handsearching of reviews and reference lists. Search terms will include DD, food variety, mixed diet, balanced diet and food group variety. Eligible articles must include a measure for DD as an indicator of diet quality in the general population living in developed settings. Two independent reviewers will screen titles or abstracts, and read full-texts. Consensus will resolve any disagreements on study eligibility with a third reviewer consulted if needed. Data will be extracted using a standardised evidence table and analysed using a narrative synthesis approach. Data will be managed using Covidence.

ETHICS AND DISSEMINATION

No ethics is required for this study using public documents. Results will be disseminated through peer-reviewed papers and scientific conferences.

DISCUSSION

This scoping review will help to map, classify and assess the methodological approaches used in the nutrition literature to measure DD as a diet quality indicator. We anticipate a wide range of DD measures and expect to identify the most prevalent DD measures used to assess diet quality. Our findings will inform standardisation to improve future research on this nutritional concept.