Associations of dietary diversity scores and micronutrient status in adolescent Mozambican girls
- 385 Downloads
In low-income settings, dietary diversity scores (DDSs) often predict the micronutrient adequacy of diets, but little is known about whether they predict levels of biochemical indicators of micronutrient status.
In 2010, we studied two samples of non-pregnant 14- to 19-year-old girls in central Mozambique, the first in January–February (‘hunger season’; n = 227) and the second in May–June (harvest season; n = 223). In this paper, we examined whether a low Women’s Dietary Diversity Score (WDDS) predicts a low concentration of haemoglobin, serum ferritin, zinc, and folate, and plasma retinol in adolescent Mozambican girls. We constructed three scores: WDDS based on 24-h recalls, WDDS15g based on 24-h recall and employing a 15 g limit, and 7dWDDS based on 7-day food frequency questionnaires. Logistic regression models, stratified by season, were used to estimate the odds of having a low concentration of a status indicator (≤25th percentile of the season-specific distribution or cut-off from the literature) in those with a low score compared to those with a higher score.
In January–February, after adjusting for confounders, a low (≤3) WDDS and a low (≤5) 7dWDDS were each associated with higher odds of having low serum zinc compared to having a higher score, regardless of which of the two types of cut-offs for serum zinc was used. These associations were not present in May–June.
Our data from Mozambique suggest that dietary diversity is associated with serum zinc, but this association seems to be limited to the hunger season.
KeywordsDietary diversity score Micronutrient Nutritional status Adolescent girl Mozambique Sub-Saharan Africa
We are deeply grateful for all those who helped to make the ZANE Study possible, especially the field workers and study participants. This research was supported by the Academy of Finland, Embassy of Finland in Maputo, the Finnish Graduate School on Applied Bioscience: Bioengineering, Food and Nutrition, Environment, the Future Development Fund of the University of Helsinki, the Finnish Concordia Fund, and the Foundation for Women in Research, Finland.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 1.Ruel MT (2003) Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr 133:3911S–3926SGoogle Scholar
- 2.FAO (2014) Food-based dietary guidelines: food guidelines by country. http://www.fao.org/ag/humannutrition/nutritioneducation/fbdg/en/. Accessed Dec 2014
- 11.Wiesmann D, Arimond M, Loechl C (2009) Dietary diversity as a measure of the micronutrient adequacy of women’s diets: results from rural Mozambique site. Food and Nutrition Technical Assistance II Project, Academy for Educational Development, Washington, D.C. http://www.fantaproject.org/sites/default/files/resources/WDDP_Mozambique_Dec09.pdf, http://www.webcitation.org/6VYDKeWKz. Accessed Dec 2014
- 12.Kennedy G, Ballard T, Dop M (2010) Guidelines for measuring household and individual dietary diversity. FAO. http://www.fao.org/3/f31af845-f69c-5aa8-bfb4-04dea6b98e1d/i1983e00.pdf, http://www.webcitation.org/6UgtuQGHB. Accessed Dec 2014
- 15.Gebremedhin S, Enquselassie F, Umeta M (2011) Prevalence of prenatal zinc deficiency and its association with socio-demographic, dietary and health care related factors in rural Sidama, Southern Ethiopia: a cross-sectional study. BMC Public Health 11:898. doi: 10.1186/1471-2458-11-898 CrossRefGoogle Scholar
- 17.Korkalo L, Freese R, Fidalgo L, Selvester K, Ismael C, Mutanen M (2014) A cross-sectional study on the diet and nutritional status of adolescent girls in Zambézia Province, Mozambique (the ZANE Study): design, methods, and population characteristics. JMIR Res Protoc 3:e12. doi: 10.2196/resprot.3109 CrossRefGoogle Scholar
- 18.FAO (2015) A brand new global dietary diversity indicator for women [web page]. http://www.webcitation.org/6czEcMWVG. Accessed Nov 2015
- 19.WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. http://www.who.int/vmnis/indicators/haemoglobin/en/. Accessed Apr 2014
- 20.WHO (2011) Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. http://www.who.int/vmnis/indicators/ferritin/en/. Accessed Apr 2014
- 21.International Zinc Nutrition Consultative Group (IZiNCG), Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC et al (2004) International Zinc Nutrition Consultative Group (IZiNCG) technical document #1. assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull 25:S99–S203CrossRefGoogle Scholar
- 22.WHO (2011) Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations. http://www.who.int/vmnis/indicators/retinol/en/. Accessed Apr 2014
- 23.WHO (2012) Serum and red blood cell folate concentrations for assessing folate status in populations. http://www.who.int/vmnis/indicators/serum_RBC_folate/en/. Accessed Apr 2014
- 25.Lumley T (2013) Survey: analysis of complex survey samples. R package version 3.29-5. http://cran.r-project.org/web/packages/survey/. Accessed Feb 2014
- 26.R Core Team (2013) R Project for statistical computing. Version 3.0.2. R Foundation for Statistical Computing. http://www.r-project.org/. Accessed Feb 2014
- 27.Krebs-Smith SM, Kott PS, Guenther PM (1989) Mean proportion and population proportion: two answers to the same question? J Am Diet Assoc 89:671–676Google Scholar