Food Variety and Dietary Diversity as Indicators of the Dietary Adequacy and Health Status of an Elderly Population in Sharpeville,South Africa

ABSTRACT

This cross-sectional, analytical study was a comprehensive health assessment focusing on dietary quality of 170 randomly selected elderly respondents in Sharpeville, South Africa. The methods included a sociodemographic, health food frequency questionnaire, 24 h-recall questionnaires, and anthropometric and biochemical measurements. The low mean±standard deviation (SD) dietary diversity score (3.41±1.34) and food variety score (4.77±2.2) compared with poverty parameters confirmed household food insecurity in this community. Although three (n = 99, 58.6%) or two (n = 49, 28.9%) daily meals were mostly consumed, these were mainly carbohydrate-based and nutrient-deficient. The cereal group (2.01±0.81) had the highest mean food variety score ±SD, followed by dairy (0.62±0.53) and flesh foods (0.40±0.53). When a mean adequacy ratio of 70% was used as a cut-off point for nutrient adequacy, it was found that the food variety score must be eight or higher and the dietary variety score must be at least six. These indicators thus have a high ability to identify those respondents with an inadequate diet but lower ability to identify those respondents with a nutritionally adequate diet. The data further showed a trend that with a higher food variety and dietary diversity, a better mean adequacy ratio is reached for this low-income group of elderly subjects. In conclusion, the results showed that food variety and dietary diversity scores give a fairly good assessment of the adequacy of the diet, and scoring dietary diversity is a significant, yet simple tool to identify elderly persons at risk of food and nutrition insecurity.     

Dietary diversity and adequacy of women caregivers in a peri-urban informal settlement in South Africa

Objective

Simple measures reflecting dietary quality are preferred for assessment of dietary intakes in low-income communities, e.g. dietary diversity that reflects a healthy, varied, nutritious diet, associated with nutrient adequacy. A strong association between household income and food access suggests dietary diversity assessment as one of the indicators of household food security. The aim of this study was to assess the food security situation of black women in an informal settlement by exploring their food access capabilities through dietary diversity measures and the coping strategies they employ to cope with poverty and hunger.

Methods

A randomly selected sample of black women living in an informal settlement completed a pretested socio-demographic questionnaire (socio-economic circumstances) and validated questionnaires (1-wk quantified food frequency questionnaire: diversity measures; 24-h recall: nutrient intake; Cornell Hunger Scale: coping strategies). Food variety scores and food group diversity scores were calculated from frequency analyses for all foods and food groups. Nutrient adequacy ratios for various nutrients and the mean adequacy ratio for their diet were calculated. Relationships between dietary diversity and nutritional adequacy were investigated with Pearson correlations. Food variety score cut points were tested for sensitivity and specificity against nutritional adequacy.

Results

Intakes were deficient for all nutrients except carbohydrates. Individual mean ± SD nutrient adequacy ratios ranging between 0.15 ± 0.18 and 0.95 ± 0.19 confirmed the poor dietary quality. Zero to 40 individual foods were consumed, but the mean ± SD food variety score was only 3.17 ± 1.21, indicating low food diversity, as did the low dietary diversity score (2.82 ± 0.99) using 0 to 6 food groups.

Conclusions

Limited food access and food variety in poor households resulted in inadequate nutrient intakes (low nutrient adequacy ratios), confirmed by poor dietary diversity (food variety score and food group diversity score). Dietary diversity assessment can successfully replace traditional dietary assessment tools in poverty-stricken or low-income communities where quick assessments are often required to assess the greatest need.     

Impact of food aid on food variety and dietary diversity of an elderly community in Sharpeville, South Africa

Objective  The objective of this paper was to discuss the impact of a two-year food aid intervention programme on dietary diversity and adequacy of an elderly community. This project was undertaken amongst the elderly (n=300), voluntarily attending a day care centre in Sharpeville, South Africa. In a baseline study (2004) in this community the dietary diversity scoring (DDS) method revealed low dietary diversity (3.41) and food variety (4.77) scores (FVS), and a trend that higher scores resulted in a better mean nutrient adequacy ratio. An intervention study, implemented in 2005, aimed to improve the dietary diversity of this elderly community by providing breakfast and lunch five days a week at the care centre. The impact of this food aid was investigated by comparing the DDS, FVS and nutrient adequacy ratios (NAR) before and after the intervention. Methods  The methods included socio-demographic, health, food frequency questionnaire (FFQ), 24 hour-recall (24h-recall), anthropometric and biochemical measurements in 107 elderly people who regularly attended the care centre since 2004. Results  At baseline, the majority of respondents (n=82, 55.1%) were classified with low DDS utilizing 0–3 food groups compared to after the intervention, where 98.1% (n=105) was classified with a high dietary diversity utilizing all nine nutritious food groups. The mean individual DDS of 3.41 that improved to 8.5 after the intervention further supported this. The mean adequacy ratio (MAR) showed a statistically significant improvement from baseline (0.77±0.48) to 1.02±0.66 after the intervention, indicating improvement of the adequacy of the overall diet to meet the daily requirements for this elderly community. Conclusions  The results of this study represent the first demonstration that food aid proved to be an effective short term nutrition intervention that improved the level of dietary diversity. Other food-based approaches or nutrition education activities should be implemented simultaneously to improve self-sufficiency in such a community for long-term effectiveness in terms of nutrient inadequacy and dietary diversity.     

Nutrient adequacy and dietary diversity in rural Mali: association and determinants

OBJECTIVE: To examine the association between nutrient adequacy and dietary diversity, and to assess and compare the determinants for the two constructs in an adult population in rural Mali. DESIGN: Cross-sectional study assessing food intake by a validated 7-day quantitative food frequency questionnaire. Two different dietary diversity indexes were created: food variety score (FVS), a simple count of food items, and diet diversity score (DDS) a count of food groups. Mean adequacy ratio, the mean ratio of intake to recommended intake (each truncated at one) of energy and nine nutrients, was calculated as an indicator of nutrient adequacy. Information on household and individual characteristics, including demography, socioeconomic conditions and food production strategies was obtained using precoded questionnaires. SETTING: Bafoulabé district, Kayes region, Western Mali. SUBJECTS: In total, 502 subjects (55% women) aged 15-45 y from 319 different households. RESULTS: Both FVS and DDS had a positive correlation with mean adequacy ratio (MAR). Multivariate analysis (linear regression) showed that the most important factors explaining MAR was the number of milk products, vegetables and green leaves consumed, as well as sex and the number of crops produced in the household. Dietary diversity was associated with socioeconomic status, residence and age. CONCLUSION: Dietary diversity is useful as an indicator of nutrient adequacy. It is important to examine how various food groups contribute to the nutrient adequacy of the diet in an area.     

Higher dietary variety is associated with better nutritional status in frail elderly people

OBJECTIVE: A narrow range of food choices may lead to dietary inadequacies, a particular concern in elderly people. We hypothesized that consumption of a more diverse diet would predict better nutritional status in frail elderly persons. SUBJECTS: Subjects included 98 frail nursing home residents (36 men, 62 women), mean age 87.1+/-5.5 (72 to 98) years. METHODS: 3-day dietary variety scores ranging from 23 to 48 and fruit and vegetable variety scores ranging from 5 to 20 were calculated from weighed 3-day food records as the number of different food or fruit and vegetable choices consumed. A higher score indicates a more varied diet. Nutritional status was assessed by weight, height, body mass index (BMI), skinfold thickness, circumference measures, calculated mean arm muscle area, total body water, computerized tomography of the thigh, and total body potassium, as well as nutritional analysis, biochemical measures, and subject medical history. STATISTICAL METHODS: Univariate regression analyses were performed to investigate the relationship between clinical and nutrition variables. Multiple linear regressions were used to develop models relating dietary variety scores to possible etiologic factors as well as indicators of nutritional status. Models were controlled for age, BMI, and energy intake when appropriate. RESULTS: Mean dietary variety score was 35.2+/-4.5, and mean fruit and vegetable variety score was 11.3+/-3.0. Higher dietary variety score was associated with higher energy intake (beta = 20.5, P < .001) and both high dietary variety score and fruit and vegetable variety score were positively associated with intake for many nutrients (P < or = .05). High dietary variety score was related to high fruit and vegetable variety score and total intake of fruits and vegetables. In men, higher dietary variety score and fruit and vegetable variety score were associated with higher high-density lipoprotein (beta = 1.02), lower very-low-density lipoprotein (beta = -3.58) and triglycerol (beta = -3.51), and higher blood folate (beta = 4.72) concentrations in women (P < or = .05). In women, high dietary variety score was associated with higher BMI (beta = 0.34, P < .001) and higher total body potassium (beta = 1.30, P = .02); high fruit and vegetable variety score was associated with higher BMI (beta = 0.41), mid-arm circumference (beta = 0.34), and mid-arm muscle area (beta = 2.94) (P < or = .03). Dietary variety score was higher (mean 37.6+/-5.38 vs 34.6+/-4.14) in those who received assistance with feeding (beta = 2 .67, P = .01). History of cancer (beta = -2.04) and gastrointenstinal cancer (beta = -3.54) were associated with low dietary variety score (P < or = .05). CONCLUSIONS: The results of this study suggest that a highly varied diet in elderly nursing home residents is associated with better nutritional status as assessed by nutrient intake, biochemical measures, and body composition measures. Dietary variety score is a straightforward tool for screening and identifying people at nutritional risk, as well as a mechanism for monitoring response to nutritional, medical, and environmental interventions. Preventive measures to improve dietary variety, as measured by the dietary variety score, should be evaluated and introduced before nutrition and health complications arise.     

Dietary diversity within food groups: an indicator of specific nutrient adequacy in Tehranian women

OBJECTIVE: To determine the relationship between dietary diversity within food groups and dietary diversity score and the probability of nutrient adequacy in Tehranian women. DESIGN: Cross-sectional study assessing food intake by two 24-hour recalls questionnaires on two different occasions. Dietary diversity was defined according to diet quality index revised. The mean probability of adequacy across 14 nutrients was calculated using the Dietary Reference Intakes. SETTING: District 13 of Tehran, Iran. SUBJECTS: 286 females aged 18-80 years. RESULTS: Whole grain diversity score mostly correlated with protein and vitamin B2 (r = 0.35, p < 0.05). Fruit diversity score was correlated with vitamin C (r = 0.44, p < 0.05). Dairy diversity score was correlated with calcium intake (r = 0.54, p < 0.05). Meat diversity score was correlated with protein intake (r = 0.34, p < 0.05). Most subjects failed to meet vitamin B6, zinc, magnesium, calcium, copper, and vitamin B12 adequacy. Energy intake was a strong predictor of the mean probability of adequacy in models controlled for age, BMI, education level and job status (model R2 = 0.53). Adding the number of servings from each of the food group to the models significantly improved the model fit (model R(2) = 0.59). Adding the dietary diversity score improved the model fit significantly (model R2 = 0.64). Dairy diversity score had the strongest association with improved nutrient adequacy. CONCLUSION: Dietary diversity score is a useful indicator of specific nutrient adequacy in Tehranian women. However, to determine the adequacy of a specific nutrient, the diversity scores of specific food groups might be taken into account.     

Dietary diversity score in adolescents - a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study

The purpose of this study was to determine dietary diversity and its relation to dietary adequacy in 10-18 year-old adolescents of district 13 of Tehran during the period 1999-2001. After excluding for over and under reporters, dietary intake assessment was conducted on 304, 10-18 year old individuals, participants of Tehran Lipid and Glucose Study. A dietary diversity score was calculated as part of the pyramid serving database that is categorized into 23 broad food groups. Each of the 5 broad food categories received a maximum diversity score of 2 of the 10 possible score points. To be counted as a "consumer " for any of the food groups categories, a respondent needed to consume one-half serving, as defined by Food Guide Pyramid quantity criteria, at any time during a 2-day survey period. The nutrient adequacy ratio for a given nutrient is the ratio of a subject's intake to the current recommended allowance for the subject's sex and age category. Weight and height were measured and BMI was calculated. Student's t-test was used to compare the means. Those variables which had normal distribution were tested by Pearson correlation coefficient and the others were tested by the Spearman correlation coefficient. Mean +/-SD of dietary diversity score (DDS) was 6.25 +/- 1.08 (range 0-10). The maximum and minimum scores of dietary diversity were related to the fruit (1.46+/-0.61) and bread-grain (0.95+/-0.27) groups, respectively. Significant positive correlation was observed between DDS and the mean adequacy ratio (MAR) (r =0.42, P <0.001). Fifty percent of people had DDS >or = 6. In people with a DDS of six or over, BMI was higher (19.81 +/- 4.08vs18.95+/- 3.30 Kg/m(2), P<0.01) than others. There was a significant and positive correlation between DDS and most of the nutrient adequacy ratios (NARs). It is concluded that DDS is an appropriate method to evaluate nutrient intake adequacy in this group of adolescents.     

A more diversified diet among Mexican men may also be more atherogenic

The objective of this study was to assess the nutritional quality of Mexican men's diet and its relation to socio-economic status (SES) and BMI. A random sample of 325 Mexican men, aged 35-65 y and stratified by SES and urban or rural residence, took part in the study. Two nonconsecutive 24-h dietary recalls were conducted in person. Dietary diversity was based on the consumption of 24 food groups. The micronutrient adequacy score that was used as a cut off was 75% of the U.S. RDA (Institute of Medicine) for 13 vitamins and minerals. A prevention score assessed subjects' adherence to 8 WHO dietary recommendations for the prevention of chronic diseases. Dietary diversity and micronutrient adequacy increased with SES status of urban subjects; these indices were also significantly higher among urban poor than among rural poor. In contrast, the prevention score tended to be higher among the poorer urban and rural respondents. Dietary diversity was significantly higher but the preventive score was significantly lower in obese subjects than in normal BMI subjects. There was a positive correlation between diet diversity and micronutrient adequacy (r = 0.34, P < 0.01), whereas dietary diversity and the prevention score were inversely correlated (r = -0.21, P < 0.01). The inverse association of dietary diversity and the prevention score was stronger in rural than in urban subjects. Dietary diversity was positively and significantly correlated with fruit and vegetable intake (r = 0.295, P < 0.001). It was, however, also positively correlated with the percent of energy from total and saturated fat, and cholesterol intake. Therefore, in some settings, higher food diversity may not predict a healthier diet from the standpoint of the prevention of chronic diseases.     

Evaluation of the Nutrient Guide as a dietary assessment tool

The purpose of this study was to evaluate the validity of the Nutrient Guide as a quantitative estimate of dietary adequacy. Using 24-hour dietary recalls of 300 men, food group and overall diet scores based on the Nutrient Guide were compared with nutrient adequacy ratios for eight nutrients and a mean adequacy ratio derived from nutrient analysis. Caloric, fat, and sodium intakes estimated using Nutrient Guide ratings were also compared with nutrient Nutrient Guide ratings were also compared with nutrient analysis estimates. Correlations between food group scores and nutrient adequacy ratios were all positive and significant. Regression analyses revealed a strong linear relationship between caloric, fat, and sodium intakes estimated by the two methods and a curvilinear relationship between mean adequacy ratio and total diet score. These results suggest that the Nutrient Guide can be used to provide a reasonable estimate of adequacy for the nutrients upon which the guide is currently based. Food group and total diet scores in either the upper or lower ends of the score ranges seemed to be better predictors of individual nutrient or overall dietary adequacy than did mid-range scores, which slightly underestimated dietary adequacy of the selected nutrients.     

Dietary Diversity within Food Groups: An Indicator of Specific Nutrient Adequacy in Tehranian Women

Objective: To determine the relationship between dietary diversity within food groups and dietary diversity score and the probability of nutrient adequacy in Tehranian women.

Design: Cross-sectional study assessing food intake by two 24-hour recalls questionnaires on two different occasions. Dietary diversity was defined according to diet quality index revised. The mean probability of adequacy across 14 nutrients was calculated using the Dietary Reference Intakes.

Setting: District 13 of Tehran, Iran.

Subjects: 286 females aged 18–80 years.

Results: Whole grain diversity score mostly correlated with protein and vitamin B₂ (r = 0.35, p < 0.05). Fruit diversity score was correlated with vitamin C (r = 0.44, p < 0.05). Dairy diversity score was correlated with calcium intake (r = 0.54, p < 0.05). Meat diversity score was correlated with protein intake (r = 0.34, p < 0.05). Most subjects failed to meet vitamin B₆, zinc, magnesium, calcium, copper, and vitamin B₁₂ adequacy. Energy intake was a strong predictor of the mean probability of adequacy in models controlled for age, BMI, education level and job status (model R² = 0.53). Adding the number of servings from each of the food group to the models significantly improved the model fit (model R² = 0.59). Adding the dietary diversity score improved the model fit significantly (model R² = 0.64). Dairy diversity score had the strongest association with improved nutrient adequacy.

Conclusion: Dietary diversity score is a useful indicator of specific nutrient adequacy in Tehranian women. However, to determine the adequacy of a specific nutrient, the diversity scores of specific food groups might be taken into account.     

Simple measures of dietary variety are associated with improved dietary quality

The objective of this study was to identify a measure of dietary variety that was associated with improved dietary quality and easily understood by consumers. Dietary quality was measured by nutrient adequacy and intakes of added sugars, saturated fat, cholesterol, and sodium. We developed four definitions of dietary variety: (a) a count of basic commodities consumed; (b) a count of food codes reported; (c) a count of five Food Guide Pyramid (FGP) food groups consumed; and (d) a count of 22 FGP subgroups consumed. The analysis sample included 4,964 men and 4,797 women aged 19 years and older who participated in the Continuing Survey of Food Intakes by Individuals 1994-96. For each day of dietary data, we examined associations of each type of dietary variety with several measures of dietary quality using Spearman's correlations and multivariate linear regression models. After adjusting for energy intake and the number of FGP food group servings, all types of dietary variety were positively associated with mean nutrient adequacy across 15 nutrients, but associations were strongest for commodity-based variety and for 22 FGP subgroup consumption variety. Likewise, all variety measures were inversely associated with intakes of added sugars and saturated fat, with commodity-based variety and 22 FGP subgroup variety the strongest. We conclude that variety measured using 22 FGP subgroups is preferable because it is a good predictor of dietary quality, is relatively simple to calculate, and is easy to explain to consumers.     

Zinc status and dietary quality of type 2 diabetic patients: implication of physical activity level

The purpose of this study was to analyze the relationships among zinc status, diet quality, glycemic control and self-rated physical activity level of type 2 diabetic patients. Dietary intakes for two non-consecutive days were measured by 24-hour recall method for seventy-six diabetic patients. Fasting blood glucose and HbA1c were measured for the assessment of glycemic control. We evaluated the extent of dietary adequacy by the percentage of subjects with a dietary intake of a nutrient less than the estimated average requirement(EAR), the dietary diversity score(DDS) and the dietary variety score(DVS). Zinc status was assessed from serum levels and urinary excretion. Dietary inadequacy was serious for five nutrients: riboflavin, calcium, thiamin, zinc and vitamin C. Dietary intakes from the meat, fish, and egg food groups and the milk food group were below the recommended level. We found that subjects with high levels of physical activities had significantly higher DVS and serum zinc levels compared to others (p<0.05). Fasting blood glucose levels and HbA1c were not significantly different across self-reported physical activity levels. Therefore, we suggest that maintaining physical activity at or above a moderate level is beneficial to improving dietary quality and zinc status.     

Dietary patterns in pregnant women: a comparison of food-frequency questionnaires and 4 d prospective diaries

There is growing interest in the use of dietary patterns as measures of exposure in studies of diet-disease relationships. However, relatively little is known about the impact of the type of dietary assessment method on the patterns observed. Using FFQ and food diary data collected from 585 women in early pregnancy we used principal component analysis to define dietary patterns. The first pattern was very similar in both datasets and was termed the 'prudent' diet. The second pattern, whilst comparable for the FFQ and food diaries, showed greater variation in coefficients than the prudent pattern; it was termed the 'Western' diet. Differences between the FFQ and diary scores were calculated for each woman for both the prudent and Western diet patterns. Of the differences in the prudent diet score, 95 % lay within +/- 1.58 sd of the mean, and 95 % of the differences in the Western diet scores lay within +/- 2.22 sd of the mean. Pearson's correlation coefficients were 0.67 (P < 0.001) for the prudent diet score and 0.35 (P < 0.001) for the Western diet score. The agreement between the FFQ and diary scores was lowest amongst respondents who were younger, had lower educational attainment and whose diaries were coded as 'poor, probably incomplete', although these effects were small. The first two dietary patterns identified in this cohort of pregnant women appear to be defined similarly by both FFQ and diary data, suggesting that FFQ data provide useful information on dietary patterns.     

Urinary potassium is as reliable as urinary nitrogen for use as a recovery biomarker in dietary studies of free living individuals

Twenty-four-hour urinary nitrogen (UN) is commonly used to validate dietary assessment methods. Potassium is more widespread in food than nitrogen, but the role of 24-h urinary potassium (UK) as a biomarker has been less studied and characterized. To investigate the performance of UK as a recovery biomarker compared with UN in subjects consuming their normal diet, 7 males and 6 females consumed known amounts of food based on their habitual varying diet (assessed beforehand from 4 consecutive 7-d food diaries) for 30 d in a metabolic suite. All daily urine samples and dietary duplicates were collected, and N and K were measured. Stool K was determined in 5-d pooled samples. Thirty-day mean analyzed K intake was 121.3 +/- 25.1 (mean +/- SD) mmol/d. Overall, 77 +/- 6.7% of K in the diet was excreted in urine and 18 +/- 5% in stool. Dietary K was correlated with UK (r = 0.89; P < 0.001). UN was 77.7 +/- 6.6% of N intake and was correlated with N in the diet (r = 0.87; P < 0.001). When 16 d of intake and 8 d of urine-collection measurements were randomly selected from the 30-d measurements, correlations were significant for both K (r = 0.86; P < 0.001) and N (r = 0.92; P < 0.001). The high correlations between UK and K in the diet show that UK is a reliable recovery biomarker for use in studies of dietary measurement error. Factors for use of urinary N as a recovery biomarker are also confirmed.     

Predictors of food variety and dietary diversity among older persons in Botswana

OBJECTIVE: We investigated whether food variety and diversity are associated with physical and cognitive functioning in older adults in Botswana and designed a simple set of screening questions that predict food variety in this population. METHODS: Data were collected (1998) as a national household survey of 1085 subjects 60 y and older. A food variety score, based on a food frequency checklist, was calculated by summing the frequency of weekly intakes of 16 food items (0 to 66). A dietary diversity score was calculated as the number of food groups consumed weekly (0 to 5). A representative subsample (n = 393) was randomly selected for the clinical component of the survey, and measurements on dependency and cognitive function were conducted. RESULTS: Low food variety was found: 35.2%, 59.3%, and 22.4% of subjects consumed no dairy products, fruits, and vegetables, respectively. A higher food variety score was associated with urban residence, ownership of cattle, higher education, and more frequent meals, and these indicators were used to construct a nutritional risk indicator. Higher food variety score was associated with better self-reported health and better cognitive function. Similarly, a higher score on the nutritional risk indicator screening tool was associated with desirable health outcomes. CONCLUSION: A limited number of foods is consumed, leading to an overall pattern of poor food variety. Higher food variety was associated with improved physical and cognitive functions. A screening tool that predicts food variety in this population has been developed and is recommended to be incorporated at a primary care level to identify older adults most at risk of a poor quality diet.     

Food variety as a quantitative descriptor of food intake

A dietary guideline, which has been assumed by several countries, is to achieve the inclusion of a variety of foods in the diet. The major reason for inclusion of food variety as a dietary guideline is the generally accepted concept that eating a wider variety of foods improves nutrient adequacy. There may also be other reasons why food variety relates to health status. An approach for the development and use of food variety scores is presented together with a basis and logic for scoring food variety. Food variety scores quantify the number of different foods (individual foods, food mixtures, food categories, or a combination of these) consumed, and are expressed over a time period or base which may be a day, a week, a month, or a year. The ultimate approach used to calculate food variety may reflect the method by which food intake is assessed, the culture within which the score is to be applied, the definition of a distinct food, and the hypotheses and objectives of the study. If a food is consumed, a score of “one” is given. There are no assumptions about quantity, or frequency of consumption. No additional score is given for larger serving sizes, or if foods are eaten more than once over the time base. Foods which score are added together to obtain a final food variety score. A major test of the usefulness of food variety scores is their predictiveness of health outcomes, and whether relationships observed are consistent with biological explanations. Food variety, or dietary diversity scores have been used previously to demonstrate that greater dietary diversity is associated with better nutritional adequacy. A greater food variety has also been associated with improved health status.     

Which dietary diversity indicator is best to assess micronutrient adequacy in children 1 to 9 y?

ObjectivesThe aim of this study was to determine the best dietary diversity indicator to measure dietary diversity and micronutrient adequacy in children.MethodsA national representative cross-sectional survey of children ages 1 to 9 y (N = 2,200) was undertaken in all ethnic groups in South Africa. A 24-h recall was done with the mother or caregiver of each child. A dietary diversity score (DDS), the number of food groups consumed at least once in a period of 24 h, was calculated for each child in accordance with 6-, 9-, 13-, and 21-food group (G) indicators and compared with a mean adequacy ratio (MAR). The nutrient adequacy ratio (NAR) was calculated for 11 micronutrients by comparing the distributions of estimated intakes with the Estimated Average Requirements for that micronutrient. The MAR was the average of all NARs. Correlations were done between MAR and DDS and sensitivity and specificity calculated for each group indicator.ResultsPearson’s correlations between food group indicators and MAR indicate that r values were all highly significant (P < 0.0001). There were no consistent or large differences found between the different group indicators although G13 and G21 appeared to be marginally better. Sensitivity and specificity values in the current study lay between DDS of 3 and 5, suggesting one of these as the best indication of (low) micronutrient adequacy.ConclusionsOverall results seem to indicate that any of the four G indicators can be used in dietary assessment studies on children, with G13 and G21 being marginally better. A cut-off DDS of 4 and 5, respectively, appear best.     

Poor intake of milk, vegetables, and fruit with limited dietary variety by Botswana's elderly

The aim of this research was to determine dietary intake of elderly Batswana, evaluate the diet quality using the Health Eating Index (HEI), identify factors associated with poor quality, and determine the impact of age on dietary scores. Villages and towns were selected in three strata: urban, semi-urban, and rural. A total of 99 elderly (67% female, 33% males), age range 60-95 years, were recruited through purposive sampling. A 24-hour multiplepass food recall was combined with demographic, health, and cooking responsibilities questions. The elderly diet met requirements for only the Grains group (9 serving/day). Most elderly obtained good HEI component scores on fat, saturated fat, cholesterol, sodium, and Grains group intake. The HEI scores were poor for variety, milk, fruits, and vegetables. Most elderly had poor diet (38%) or a diet that needed improvement (59%), and only 3% had a good diet.     

我国成人膳食多样化与营养素摄入充足状态的关系

目的以膳食多样化评分(DDS)为评价指标,了解我国18～59岁城乡居民膳食多样化现状,及其与营养素摄入状态的关系。方法利用2002年中国居民营养与健康状况调查中3 d的24 h膳食回顾调查数据,计算膳食多样化总评分(DDS)以及不同食物种类组内DDS,分析与17种营养素摄入充足比(NAR)和平均充足比(MAR)的关系。结果农村地区居民DDS低于城市居民;农村居民膳食中蔬菜多样化分值高于城市,而鱼、蛋、肉、乳及水果DDS较低;我国居民膳食中最易缺失的食物品种是乳制品,其次是水果和鱼类。MAR值随DDS的增加而增加;DDS与MAR显著正相关(r=0.27～0.43),各类食物的组内多样化与MAR亦显著正相关,肉类、蔬菜和豆制品的相关系数分别为0.30、0.25和0.22,肉类食物对MAR的贡献最大。DDS与能量、蛋白质、脂肪、钙、磷、钾、钠、镁、锌、铁、硒、维生素A、E、C、尼克酸、硫胺素、核黄素的NAR以及NAR-N均显著正相关。结论城市居民膳食多样化程度高于农村,我国城乡居民膳食中最易缺少的食物品种是乳制品;膳食多样化与营养素摄入的充足状态显著相关。     

A comparison of food group variety between toddlers with and without cystic fibrosis

OBJECTIVES: To compare the food group variety and nutritional adequacy of the diet between toddlers with cystic fibrosis (CF) and age-matched controls. Subjects A clinical sample of 22 toddlers with CF (mean age=21.3 +/- 7.2 months) matched to a community sample of 22 healthy peers. MAIN OUTCOME MEASURES: The variety index for toddlers (VIT) and the mean adequacy ratio (MAR). RESULTS: Fruit group scores were highest for children with CF (0.95 +/- 0.13; possible range 0.00-1.00), and dairy group scores were highest for controls (0.90 +/- 0.18). All children earned the lowest scores for vegetables (CF: 0.15 +/- 0.12; controls: 0.26 +/- 0.22). No significant differences were found when comparing VIT and MAR scores by sample (P >0.05). A moderate positive relationship was found between total VIT scores and MAR scores for all children (r=0.38, P <0.05). Toddlers with CF did not achieve the 120-150% of Recommended Dietary Allowance (RDA) for energy. CONCLUSIONS: Toddlers with CF are consuming diets that are varied and nutritionally adequate for a healthy child. To optimize nutritional status and growth, current recommendations for toddlers with CF to eat a well-balanced diet and to exceed daily RDA for energy requirements remain key dietary issues.