Abstract
Backgrounds
Undiversified and monotonous diets can lead to deficiency disease, named micronutrient deficiency, more specifically among young children. Dietary diversity (DD) has been known as a valid indicator to assess micronutrient inadequacy of the diet. The aim of this study was to determine “is there an association between high dietary diversity and the micronutrient adequacy, in children under 5 years old?”.
Methods
PubMed, Scopus, ScienceDirect, Web of Sciences, and Google Scholar databases were searched until February 2022, without date restrictions, using relevant keywords. All original articles, written in English, evaluating the relationship between DD and micronutrient adequacy in children under 5 years were eligible for this review.
Results
Totally, 1814 records were found in electronic search databases; after removing duplicated and irrelevant studies according to the title and abstract, the full text of the 35 articles was critically screened, in which 15 cross-sectional studies were included in this review. All of these studies reported that DD of infants and children under 5 years was positively associated with their micronutrient adequacy.
Conclusion
The findings indicate that in infants and children under 5 years, intake of various food groups reveals the adequate intake of micronutrients.
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Background
Micronutrients are the essential vitamins and minerals required to sustain almost all normal cellular and molecular functions [1]. Micronutrient deficiency (MND) is defined as the percentage of individuals whose micronutrient intake is less than the estimated average requirement [2]. While the micronutrient required amounts are minimal, MND can have several negative impacts on health such as developmental problems that if left untreated will ultimately lead to death [3]. MND is coming to be the most prevalent nutritional deficiency [4] that based on World Health Organization (WHO) reports affects an estimated 2 billion people in the world [5]. The prevalence of MND has increased in the early stages of life due to poor feeding during this period and children under 5 years of age and younger are at the highest risk and one of the most vulnerable population subgroups [6, 7].
The nutritional quality of infants and young children is a public health concern in the world [8]. These age-groups require diets with high nutrient density and variety because of their rapid growth and development [9]. Inadequate intake of micronutrients is primarily responsible for the deficiencies that are due to poor quality of diet and monotonous diets [10, 11]. Dietary diversity (DD) is a good predictor of dietary quality and has been known as a valid indicator to assess micronutrient inadequacy of the diet, more specifically among infants and young children, by FAO [12,13,14]. Assessment of DD helps to determine whether the child’s diet has the important elements needed for growth. Intake of a wide variety of foods increases micronutrient adequacy that is necessary for better growth and proper nutrition of children [15].
Many studies have reported that children's diets are rich in energy-dense micronutrient-poor foods and they are not eating enough fruit and vegetables [8, 16, 17]. Children under 5 years of age remain the most vulnerable group to malnutrition and micronutrient deficiency as chronic malnutrition. To our best knowledge, there is no systematic review study evaluating the relationship between DD and micronutrient adequacy in infants and young children. Hence, the research question is that “Does high dietary diversity scores predict dietary micronutrient adequacy in children under 5 years old? Therefore, this systematic review was carried out to summarize the present evidence of the relationship between DD and micronutrient adequacy in children under 5 years.
Method
The protocol of the study was registered and approved by the Research Vice-Chancellor of Tabriz University of Medical Sciences (Research ID: 66585).
Data sources and search strategy
The present systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [18] by focusing on the relationship between DD and micronutrient adequacy. This study was performed using the related keywords (“Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety” and “micronutrient*” and “children or infant”) on the electronic databases including PubMed, ScienceDirect, Scopus, and Google Scholar. Moreover, to ensure the inclusion of all eligible studies, forward and backward citation was tracked for all of the included studies. The search was limited until February 2022. The method of the database search strategy is shown in Additional file 1: Table S1.
Eligibility criteria and screening method
Articles published in the English language that examined the relationship between DD and micronutrient adequacy in infants or children under 5 years were included in the present study. The exclusion criteria were book chapters, conference abstracts, letters, posters, editorial, commentary, thesis, and review articles. Moreover, articles that studied the relationship between household DD and micronutrient adequacy or performed on other age-groups, and studies that their full text was not available were excluded from this review.
After removing the duplicate studies using the EndNote software (Version X9; Thomson Reuters, Philadelphia, PA, USA), two independent investigators initially screened titles and abstracts of the searched studies based on the inclusion and exclusion criteria. In the second step, the full text of papers that were eligible was assessed and studies that had sufficient information or could meet the predefined criteria were included in this review.
Data extraction
The following data were extracted from selected studies: the first authors' name, year of publication, study location and design, age of children, sample size, method and duration of food intake assessment, number of considered food groups, classification of DD, DD and micronutrient density adequacy (MDA) criteria, adjusted covariates, findings with respect to the relationship between DD and micronutrient adequacy, and p value.
Assessment of articles’ quality and risk of bias
The quality of the selected articles was assessed by the two independent authors using the d for cross-sectional studies [19] based on the following criteria: representativeness of the sample, sample size, ascertainment of exposure, and non-respondents, the subjects in different outcome groups are comparable, assessment of outcome, confounding factors are controlled. The adopted Newcastle–Ottawa scale score includes maximum of 10 points for cross-sectional studies and if the overall score was within 7–10 points (≥ 4 points in the section of selection, 1 point in the comparability section, ≥ 2 points in the section of exposure/outcome), the study is known as good quality [19].
Results
Selection of studies
In the initial search, 1322 records were found in electronic search databases including PubMed (n = 37), Scopus (n = 127), ScienceDirect (n = 628), Web of Sciences (n = 475), and Google Scholar (n = 55). After removing duplicates, 514 articles remained for further screening. Firstly, articles screened according to the title and abstract of those 477 studies were excluded for reasons: review articles (n = 88), book chapter (n = 7), and irrelevant studies (n = 384). Finally, the full text of the 35 remained articles was critically screened, of which 20 articles were excluded because they studied DD or micronutrient adequacy status only (n = 4), studied the effects of nutrition program on micronutrient intake and DD (n = 4), studied the household DD (n = 4), was on other age-groups (n = 3), studied on children aged 4–8 [20] and 3–17 [2] years, but did not report the results under 5 years separately (n = 2), and irrelevant studies (n = 3). No additional articles were found through forward and backward citation tracking of the eligible studies. Therefore, 15 studies that all had cross-sectional designs were included in this review (Tables 1, 2, and 3). PRISMA diagram for the process of the search and selection of this review is presented in Fig. 1.
Quality of the articles
As shown in Additional file 2: Table S2, the mean quality score for cross-sectional studies was 9 out of 10. Thus, the majority of the studies had satisfactory scores, since, most of them used the appropriate methods for the recruitment of participants and included large sample sizes that were representative of the average in the wide community. Also, most of the included studies used the WHO guidelines for the definition of DD and MDA and controlled the potentially important confounders.
Characteristics of the included studies
Because in some articles data were limited to only infants and in some only to preschoolers and in some others to under 5 years, the results were presented in three categories, accordingly. As presented in Tables 1, 2, and 3, around 53% of the included studies used WHO guidelines for the definition of DD and MDA and about 26% of the studies used Food and Agriculture Organization (FAO) guidelines. According to WHO guidelines, the consumption of four or more food groups of seven food groups was defined as minimum dietary diversity (MDD) or good DD. In order to determine the nutrient adequacy of the diet, the nutrient adequacy ratio is the ratio of a subject’s nutrient intake to the estimated average requirement calculated by the FAO/WHO recommended micronutrient (vitamins A, B6, B12, and C, niacin, thiamin, riboflavin, folate, calcium, iron, and zinc) intakes for children, was calculated for each of micronutrients. Nutrient intakes were assessed as inadequate, fairly adequate, and adequate intake if NAR < 66%, NAR = 66% to < 100%, and NAR ≥ 100%, respectively. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated micronutrients divided by the number of micronutrients evaluated, expressed as a percentage. MAR ≥ 75% was considered as an adequate intake of micronutrients. For both NAR and MAR, a value of 100% is ideal because it shows that the intake is the same as the requirement. Other indicators of micronutrient adequacy including the probability of adequacy (PA), mean probability of adequacy (MPA), MDA, and mean micronutrient density adequacy (MMDA) also were obtained by similar methods. Hence, NAR, MAR, PA, MPA, MDA, and MMDA refer to individual micronutrients level adequacy.
Above 57% of the studies were conducted in low-income countries and the studies were from both rural and urban regions. Results of the multivariate analysis were considered to evaluate the relation of the DDS with micronutrient adequacy, in this review. Except for one, all of the studies considered covariates such as age, sex, and energy intake in the analysis.
Relationship of DD with micronutrient adequacy in infants (under 2 years old)
As presented in Table 1, totally, seven studies evaluated the relationship of DD with micronutrient adequacy in infants. All the studies reported that DD was positively associated with micronutrient adequacy.
Relationship of DD with micronutrient adequacy in children of 2–5 years old
Totally, five studies evaluated the relationship between DD and micronutrient adequacy in children of 2–5 years. All the studies showed that high DD was associated with micronutrient adequacy in children (Table 2).
Relationship of DD with micronutrient adequacy in children under 5 years
Totally, three studies evaluated the relationship between DD and micronutrient adequacy in children under 5 years. All the studies showed that high DD was associated with micronutrient adequacy in children (Table 3).
Discussion
All the included studies reported a significant positive association between dietary diversity scores (DDS) with dietary micronutrients adequacy. Several reasons are involved in these positive associations, individuals with higher DD have more access to a variety of foods; therefore, they have higher food consumption and nutrient intake and also it reflects the more consumption of higher nutrient density and healthy foods, for example, fruit, vegetables, and whole grains, which could explain the higher intake of micronutrients [36].
In the study by Meng et al., food variety scores of fruits and vegetables and food variety scores of animal foods were positively correlated with overall micronutrient adequacy and NAR for most micronutrients. Also subjects with the high food variety scores of fruits and vegetables and food variety scores of animal foods had a lower risk of inadequate intake for most micronutrients [2]. This makes perfect sense because fruits and vegetables are rich in vitamins and minerals [37] such as carotene, potassium, vitamin C, vitamin B family, and vitamin D [38] and animal foods are an excellent source of several minerals and vitamins like magnesium, zinc, iron, calcium, and vitamins E and B [2]. Faber et al. demonstrated that more than 85% of children consumed ‘Cereals and roots/tubers’ in both rural and urban areas that less than 25% of them achieved the MDD. Diets with low micronutrient levels probably reflect the infrequent intake of fruits and vegetables as well as of foods of the animal origin [26]. Consuming more food groups will ensure an adequate intake of vitamins, especially vitamin B12 and vitamin C. But for minerals such as zinc and calcium, consuming more food groups barely affects the dose of absorption, thus we should pay attention to the lower bioavailability of minerals. Diet mostly based on plants is seldom enough to provide balanced nutrients because there are chemical substances in plants such as phytate, oxalate, and polyphenols that obstruct the absorption of minerals in the alimentary canal [39, 40]. Since deficiency of main nutrients in a basic stage of the lifecycle will be carried to the next stage in the life cycle [41], the WHO to improve micronutrient intake recommended the intake of nutrient-rich foods such as animal foods or foods fortified with micronutrients [42].
Lack of DD is a considerable problem among poor populations in the developing world because their diets are predominantly of starchy staples and few fresh fruits and vegetables with little or no animal products [43]. In the present study, 50% of the included studies were conducted in low-income countries; in the majority of them, starchy foods were the predominant staple food of children. The diets based on plants will lead to inadequate intake of mineral micronutrients and poor absorption [44]. Increasing DD and food variety can enhance the dietary intake of micronutrients. High DD also is associated with positive outcomes such as high nutrient intake, improved hemoglobin levels, improved child anthropometric measurements, and reduced mortality [30]. At all, the intake of nutrients below the recommended level of intake can result in deficiency without or with discernable clinical signs and therefore potential adverse nutritional and health consequences [45]. Elevating the diversification of diets is one of the main international strategies for improvement in the micronutrient intake and status [26]. Nevertheless, in developing countries because there is a frequent food insecurity problem, this is a difficult option for households. Furthermore, improving DD through agricultural biodiversity, specifically in the rural areas, could make an important contribution to improvements in nutritional outcomes [45].
Employing a large sample size and using valid guidelines for the definition of DD and micronutrients adequacy by the included studies were strengths of this review. Nevertheless, all of the included studies were cross-sectional and administrated in diverse seasons.
Conclusion
All of the studies included in this systematic review revealed that high DD was significantly associated with micronutrients adequacy in infants and children under 5 years old. Therefore, the findings of the current study indicate that DD could be used for screening purposes to identify the risk of micronutrient inadequacy in children. This study recommends promoting the consumption of a diversified diet to achieving adequate micronutrients by children. Enhancing agricultural biodiversity and promoting maternal nutritional information that leads to choosing the correct and various food groups can increase the DDS of children under 5 years. Also, in low-income households, if the intake of various food groups is impossible, micronutrients supplements should be used for children to attain adequate micronutrients that are required for their rapid growth and development.
Availability of data and materials
All data included in this systematic review are from previously published papers.
Abbreviations
- MND:
-
Micronutrient deficiency
- WHO:
-
World Health Organization
- DD:
-
Dietary diversity
- MDA:
-
Micronutrient density adequacy
- MDD:
-
Minimum dietary diversity
- MAR:
-
Mean adequacy ratio
- DDS:
-
Dietary diversity score
- FAO:
-
Food and Agriculture Organization
- PA:
-
Probability of adequacy
- MMDA:
-
Mean micronutrient density adequacy
References
Merson MH, Black RE, Mills AJ. Global health: Diseases, programs, systems, and policies. Burlington: Jones & Bartlett Publishers; 2011.
Meng L, Wang Y, Li T, Loo-Bouwman CA, Zhang Y, Man-Yau SI. Dietary diversity and food variety in Chinese children aged 3–17 years: Are they negatively associated with dietary micronutrient inadequacy? Nutrients. 2018;10(11):1674.
Horwitz A, Kennedy ET, Howson CP. Prevention of micronutrient deficiencies: tools for policymakers and public health workers. Washington, D.C.: National Academies Press; 1998.
Aikawa R, Khan NC, Sasaki S, Binns CW. Risk factors for iron-deficiency anaemia among pregnant women living in rural Vietnam. Public Health Nutr. 2006;9(4):443–8.
Organization WH. The world health report 2002: reducing risks, promoting healthy life, World Health Organization; 2002.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS, Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.
Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(Suppl. 2):22–33.
Laster LE, Lovelady CA, West DG, Wiltheiss GA, Brouwer RJ, Stroo M, Østbye T. Diet quality of overweight and obese mothers and their preschool children. J Acad Nutr Diet. 2013;113(11):1476–83.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.
Kulsum A, Lakshmi JA, Prakash J. Food intake and energy protein adequacy of children from an urban slum in Mysore, India–a qualitative analysis. Mal J Nutr. 2008;14(2):163–72.
Nguyen PH, Huybregts L, Sanghvi TG, Tran LM, Frongillo EA, Menon P, Ruel MT. Dietary diversity predicts the adequacy of micronutrient intake in pregnant adolescent girls and women in Bangladesh, but use of the 5-group cutoff poorly identifies individuals with inadequate intake. J Nutr. 2018;148(5):790–7.
Moursi MM, Arimond M, Dewey KG, Trèche S, Ruel MT, Delpeuch F. Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar. J Nutr. 2008;138(12):2448–53. https://doi.org/10.3945/jn.108.093971.
Zhao W, Kai Yu, Tan S, Zheng Y, Zhao Ai, Wang P, Zhang Y. Dietary diversity scores: an indicator of micronutrient inadequacy instead of obesity for Chinese children. BMC Public Health. 2017;17(1):440. https://doi.org/10.1186/s12889-017-4381-x.
Nair MK, Augustine LF, Konapur A. Food-based interventions to modify diet quality and diversity to address multiple micronutrient deficiency. Front Public Health. 2016;3:277. https://doi.org/10.3389/fpubh.2015.00277.
Habte TY, Krawinkel M. Dietary diversity score: a measure of nutritional adequacy or an indicator of healthy diet. J Nutr Health Sci. 2016;3(3):303.
Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: What foods are infants and toddlers eating? J Am Diet Assoc. 2004;1(104):22–30.
Kim SA, Moore LV, Galuska D, Wright AP, Harris D, Grummer-Strawn LM, Merlo CL, Nihiser AJ, Rhodes DG. Vital signs: fruit and vegetable intake among children—United States, 2003–2010. MMWR Morb Mortal Wkly Rep. 2014;63(31):671.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34.
Peterson J, Welch V, Losos M, Tugwell PJ. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ott Ott Hosp Res Inst. 2011;2(1):1–2.
Caswell BL, Talegawkar SA, Siamusantu W, West KP Jr, Palmer AC. A 10-food group dietary diversity score outperforms a 7-food group score in characterizing seasonal variability and micronutrient adequacy in rural Zambian children. J Nutr. 2018;148(1):131–9.
Faber M, Laubscher R, Berti C. Poor dietary diversity and low nutrient density of the complementary diet for 6-to 24-month-old children in urban and rural K wa Z ulu-N atal, S outh A frica. Matern Child Nutr. 2016;12(3):528–45.
Shanshan GE, Jingqiu MA, Shanshan LI, Zhang J, Sheng X. Lack of dietary diversity contributes to the gaps in micronutrient status and physical development between urban and rural infants. Iran J Public Health. 2018;47(7):958.
Jones AD. The production diversity of subsistence farms in the Bolivian Andes is associated with the quality of child feeding practices as measured by a validated summary feeding index. Public Health Nutr. 2015;18(2):329–42.
Khor GL, Tan SY, Tan KL, Chan PS, Amarra MS. Compliance with WHO IYCF indicators and dietary intake adequacy in a sample of malaysian infants aged 6–23 months. Nutrients. 2016;8(12):778.
Mallard SR, Houghton LA, Filteau S, Chisenga M, Siame J, Kasonka L, Mullen A, Gibson RS. Micronutrient adequacy and dietary diversity exert positive and distinct effects on linear growth in urban Zambian infants. J Nutr. 2016;146(10):2093–101.
Moursi MM, Arimond M, Dewey KG, Treche S, Ruel MT, Delpeuch F. Dietary diversity is a good predictor of the micronutrient density of the diet of 6-to 23-month-old children in Madagascar. J Nutr. 2008;138(12):2448–53.
Wondafrash M, Huybregts L, Lachat C, Bouckaert KP, Kolsteren P. Dietary diversity predicts dietary quality regardless of season in 6–12-month-old infants in south-west Ethiopia. Public Health Nutr. 2016;19(14):2485–94.
Arsenault JE, Yakes EA, Islam MM, Hossain MB, Ahmed T, Hotz C, Lewis B, Rahman AS, Jamil KM, Brown KH. Very low adequacy of micronutrient intakes by young children and women in rural Bangladesh is primarily explained by low food intake and limited diversity. J Nutr. 2013;143(2):197–203.
Diop L, Becquey E, Turowska Z, Huybregts L, Ruel MT, Gelli A. Standard minimum dietary diversity indicators for women or infants and young children are good predictors of adequate micronutrient intakes in 24–59-month-old children and their nonpregnant nonbreastfeeding mothers in rural Burkina Faso. J Nutr. 2021;151(2):412–22.
Kennedy GL, Pedro MR, Seghieri C, Nantel G, Brouwer I. Dietary diversity score is a useful indicator of micronutrient intake in non-breast-feeding Filipino children. J Nutr. 2007;137(2):472–7.
Torrico JC. Dietary diversity score as an indicator of micronutrient intake in Filipino children and adolescents. Asia Pac J Clin Nutr. 2021;30(4):696–703.
Zhao W, Yu K, Tan S, Zheng Y, Zhao A, Wang P, Zhang Y. Dietary diversity scores: an indicator of micronutrient inadequacy instead of obesity for Chinese children. BMC Public Health. 2017;17(1):1–1.
Megersa B. Dietary intake of infant and young children and assessment of dietary adequacy indicators in a pastoral setting, Southern Ethiopia. Nutr Diet Suppl. 2020;12:1.
Steyn NP, Nel JH, Nantel G, Kennedy G, Labadarios D. Food variety and dietary diversity scores in children: Are they good indicators of dietary adequacy? Public Health Nutr. 2006;9(5):644–50.
Steyn NP, Nel J, Labadarios D, Maunder EM, Kruger HS. Which dietary diversity indicator is best to assess micronutrient adequacy in children 1 to 9 y? Nutrition. 2014;30(1):55–60.
Organization WH. Guideline: assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition. 2017.
Yang J. Design tailored nutrition and weight control recommendations using nutrigenetics and FFQ. In: International conference on health information science, Springer; 2020. pp. 169–176.
Yang YJGS. Chinese food composition table. Beijing: Peking University Medical Press; 2009.
Norhaizan ME, Nor Faizadatul Ain AW. Determination of phytate, iron, zinc, calcium contents and their molar ratios in commonly consumed raw and prepared food in Malaysia. Malays J Nutr. 2009;15(2):213–22.
Sotelo A, González-Osnaya L, Sánchez-Chinchillas A, Trejo A. Role of oxate, phytate, tannins and cooking on iron bioavailability from foods commonly consumed in Mexico. Int J Food Sci Nutr. 2010;61(1):29–39.
Ndungu ZW, Chege PM. Dietary diversity and micronutrients adequacy of diets consumed by school aged children in Nairobi City County, Kenya. Nutr Food Technol. 2019.
Ruel MT. Is dietary diversity an indicator of food security or dietary quality? A review of measurement issues and research needs. Food Nutr Bull. 2003;24(2):231–2.
Zhang B, Zhai FY, Du SF, Popkin BM. The China health and nutrition survey, 1989–2011. Obes Rev. 2014;15:2–7.
Murphy SP, Poos MI. Dietary reference intakes: summary of applications in dietary assessment. Public Health Nutr. 2002;5(6a):843–9.
Ruel MT, Alderman H, Maternal and Child Nutrition Study Group. Nutrition-sensitive interventions and programmes: How can they help to accelerate progress in improving maternal and child nutrition? Lancet 2013;382(9891):536–51.
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All the three authors have made substantial contributions to the conception and design of this study. RMG conducted the search and data extraction, and the first draft of the manuscript was written by RMG; and Dr. SK and Dr. MA commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The protocol of the study was registered and approved by the Research Vice-Chancellor of Tabriz University of Medical Sciences (Research ID: 66585) and has been performed according to the PRISMA standards.
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Supplementary Information
Additional file 1: Table S1.
Does the high dietary diversity score predict dietary micronutrients adequacy in children under 5 years old? A systematic review: Method of the database search strategy using PubMed, Scopus, ScienceDirect, Google Scholar, and Web of Sciences
Additional file 2: Table S2.
Newcastle–Ottawa scale for assessment of quality of 15 included cross-sectional studies evaluating the relationship between dietary diversity and micronutrient adequacy
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Molani-Gol, R., Kheirouri, S. & Alizadeh, M. Does the high dietary diversity score predict dietary micronutrients adequacy in children under 5 years old? A systematic review. J Health Popul Nutr 42, 2 (2023). https://doi.org/10.1186/s41043-022-00337-3
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DOI: https://doi.org/10.1186/s41043-022-00337-3