Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Session 1. Arimond - Dietary Diversity Indicators


Published on

  • Be the first to comment

  • Be the first to like this

Session 1. Arimond - Dietary Diversity Indicators

  1. 1. Metrics for impact on diet quality inagricultural projects:Strengths and limitations of indicators ofdietary diversityMary ArimondIFPRI, June 6, 2013Program in International and Community NutritionUniversity of California, Davis
  2. 2. Outline• When is it appropriate to measure dietquality? - questions for project planners• Measuring diet quality – why dietary diversity?• How to operationalize & measure it• Strengths & limitations of dietary diversityindicators; some misconceptions & pitfalls
  3. 3. Questions for project planners• Is improving overall diet quality an explicit projectobjective? Do you expect diets to diversify, and if sowhy/how?• Within diet quality, is the main concern intakes ofmicronutrients? Or other dimensions of diet quality(e.g. obesigenic diets)?• Is the objective more narrow - increase intake ofsingle/few targeted foods?• Whose diet quality – entire household or targetindividual(s)?
  4. 4. Seed grants
  5. 5. Measuring diet quality –Why dietary diversity?• Dietary diversity (DD) is one important dimension ofdiet quality (also balance, moderation, etc.)• Consistently associated with micronutrient densityof the diet (infants), and micronutrient adequacy(women), in multi-site studies• Relatively simple to measure, & relevant acrossvarious cultural dietary patterns• Other multidimensional indices of diet quality can take much work toadapt and validate across settings (e.g. U.S. Healthy Eating Index)
  6. 6. Why measure dietary diversity(2)?• All food-based national dietary guidelinesinclude this dimension• Also included in WHO guidelines for feedinginfants and young children, and operationalizedin WHO indicator for global use
  7. 7. Dietary diversity and nutrient density(Working Group on IYC Feeding Indicators 2006)Breastfed infants 6-8 mo, MMDA by # food groups yesterdayMMDA“MMDA” is a measure of the adequacy of nutrient density, relative toneeds, and averaged across 9 “problem nutrients”
  8. 8. IYCF DD indicator for 6-23 moPercent with 4 or more food groups – WHO, 2008EthiopiaNigerBurkina FasoMaliDRCMozambiqueKenyaGhanaBangladeshIndiaCambodiaIndonesiaHaitiColombiaBoliviaPeru
  9. 9. Dietary diversity & micronutrient adequacy(Arimond et al., Women’s Dietary Diversity Project, J Nutr. 2010)“MPA” is probability of adequacy averages across 11 micronutrients
  10. 10. Associations between DD & other outcomes• DD is associated with height-for-age (cross-sectional studies)(Arimond & Ruel 2004; Sawadogo et al 2006; Moursi et al. 2009; Marriot etal 2012; Menon et al 2013)• But few longitudinal studies; one failed to show associationbetween DD and subsequent infant growth (length/height)(Bork et al, 2012)• In one study, DD was associated with vitamin A status inwomen in Kenya, even after adjustment for vitamin A intake(Fujita et al 2012)• In one study, DD was protective/ associated with CD4 counts,anemia, and mortality HIV+ adults (Rawat et al 2013)• DD within fruit and vegetable groups has been associated withreductions in chronic disease risk (many studies)
  11. 11. Operationalizing dietary diversity –whose?• Household-level indicators – validated againstHH-level calorie (energy) availability and NOT asan indicator of diet quality, and not for specificvulnerable individuals• Concept of mother as sentinel has beenproposed, but intake of nutrient-dense foodgroups differs between mothers and infants(Nguyen et al. 2013)
  12. 12. Operationalizing individualdietary diversity• DD has been defined & operationalized many ways– Number of individual foods vs. number of food groups(with different levels of aggregation)– Varying recall periods (yesterday & last wk most common)– Minimum quantity limits– Free recall vs. list-based recall– Indicators can be dichotomous (“% with low diversity”) orquasi-continuous scores– Guidance available (next slide) but…– Trade-offs between one-size fits all vs. project-specificindicators
  13. 13. WHO IYCF indicatorsfor global useFAO guidelines, HH &individual DD (adult)
  14. 14. Limitations of DD indicators• Measurement error and day-to-day variability indiets mean the indicators are “noisy” at individuallevel• Relatively simple, but survey instruments need tobe adapted locally (food lists and strategy forexcluding trivial amounts)• Information on responsiveness is still limited asthe indicators are new• Up to now, no consensus on a dichotomousindicator for adult women (work in progress)
  15. 15. Limited information onresponsiveness• Up to now, few studies documentingresponsiveness to interventions, shocks• Study of 2008 food price shock in Burkina Fasoshowed impact on DD (next slide)• Inclusion of indicators at baseline and post-intervention in Feed the Future projects willyield more insights in coming years (18countries, large geographic areas)
  16. 16. Response to spike in food prices*Ouagadougou4. 2008Nb of foodgroupsDecrease in dietary diversityMean DDS(Adjusted)P<0.0001Food groups thatshowed the largestpercent decreasewere nutrient-dense:Dairy, meat, poultry, fruits, vitamin A-richvegetables, nuts &seeds*(Martin-Prevel et al, presented FENS Madrid 2011)
  17. 17. Misconceptions & pitfalls• DD indicators are not a proxy for nutritionalstatus, they are a proxy for diet quality• Household-level indicators are not sufficient toassess diet quality of vulnerable groups(infants, women); some household-level indicatorsinclude non-nutritive foods/drinks• Use for population/group-level description, never forscreening/targeting individuals• For repeat uses in same population, and forcomparisons between populations, attend toseasonality
  18. 18. Dietary diversity indicators are…• …robust & useful population-level proxies ofmicronutrient density/adequacy – an importantdimension of diet quality• ….associated with growth & health outcomes, but nota proxy for theseWhen choosing or designing indicators consider:What makes sense based on intervention designComparability across sites, when this is relevantAudiences for results, communication needs
  19. 19. Thank you!World Health Organization Indicators for Assessing Infant andYoung Child Feeding Practices: Part II Measurement and Agriculture Organization Guidelines for MeasuringHousehold and Individual Dietary Diversity