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.     

Food variety and dietary diversity as indicators of the dietary adequacy and health status of an elderly population in Sharpeville, South Africa

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, 24h-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.     

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.     

Food variety and dietary diversity scores to understand the food-intake pattern among selected Malaysian households

Food variety scores (FVS) and dietary diversity scores (DDS) were estimated based on foods consumed weekly by 285 Malaysian households using a food frequency questionnaire. The scoring system of FVS and DDS was based on a scale of 0-7 and 0-6 respectively. The mean household FVS and DDS was 164.1 ± 93 and 6 ± 0.4. The age of respondents (husbands or wives; p < .01), sex (p < .05), and household food expenditure (p < .01) had a significant influence on both FVS and DDS. The food-intake pattern of Malaysian households showed that their typical diets had high protein and energy-based foods.     

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.     

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.     

A new reference method for the validation of the nutrient profiling schemes using dietary surveys

Nutrient profiles of foods are increasingly used as the scientific basis of nutritional labeling, health claims, or nutritional education. Nutrient profiling schemes are based on sets of rules, scores, or thresholds applied to the nutritional composition of foods. However, there is a lack of scientific validation of nutritional profiling schemes. To develop a reference method using existing dietary surveys, to define a set of indicator foods that are positively or negatively associated with a "healthy diet." Such indicator foods can be used both for establishing relevant nutrient profiles and for the validation of existing or future nutrient profiling schemes. The proposed validation method is based on food and nutrient intakes of adults participating in national dietary surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n = 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of indicator foods is divided in two steps. First, "healthy diets" of individuals are identified in the five national dietary surveys by comparison to the Eurodiet reference intakes. Second, indicator foods associated positively or negatively to the "healthy diets" are determined. With a P-value of 10(-3) for the test of comparison of food intakes between the "most healthy eaters" and the "less healthy eaters," it was possible to identify 294 indicator foods out of 1,669 foods tested in the five countries. In all the countries except Italy, there were more indicator foods positively associated than indicator foods negatively associated with the "healthy diet." The food categories of these indicator foods were in good agreement with Food Based Dietary Guidelines like the USDA dietary guideline for Americans. A new reference method for the validation of profiling schemes was developed based on dietary intake data from using dietary surveys in five European countries. Only a minority of foods consumed in these dietary surveys could be used as indicator foods of healthy or unhealthy diets in order to subsequently test nutritional profiling schemes. Further work is needed to build a list of indicator foods that could be considered as a "gold standard."     

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.     

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.     

Micronutrient Supplement Use and Diet Quality in University Students

Many national and international public health organisations recommend achieving nutrient adequacy through consumption of a wide variety of nutritious foods. Despite this, dietary supplement sales continue to increase. Understanding the characteristics of micronutrient supplement users and the relationship with diet quality can help develop effective public health interventions to reduce unnecessary consumption of vitamin and mineral supplements. Participants (n = 1306) were a convenience sample of students studying first year food and nutrition. Data was collected via a Food and Diet Questionnaire (FDQ) and a Food Frequency Questionnaire (FFQ). Supplement users were defined as participants who indicated consuming any listed supplement as frequently as once a month or more. Diet quality was assessed using a Dietary Guideline Index (DGI) score. Prevalence of supplement use was high in this study population with 56% of participants reporting supplement use; the most popular supplements consumed were multivitamins (28%) and vitamin C (28%). A higher DGI score was significantly associated with an increased likelihood of supplement use (mean: 105 ± 18 vs. 109 ± 17, p = 0.001). Micronutrient supplement use was associated with a higher DGI score, suggesting that supplements are more likely to be used by those who are less likely to require them.     

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.     

Diversification in indigenous and ethnic food culture

A diversified food supply is contingent on underlying biodiversity in the locality where one lives or at a distance from it, if trade routes are established. Indigenous people generally settled at the water's edge so that aquatic foods made up part of their diversified diet, with the rest of the diversity dependent on how much they hunted and gathered, on herded animals, engagement in subsistence agriculture, the ability to process and preserve food and/or food commodities traded. The rapid urbanization of much of the world's population distances people from the origin of their food, the understanding of the required commodities in the human diet (e.g., aquatic food, plant foods, lean animal foods, what animals are fed, basics of freshness). At the same time, adequacy of food intake may be more reliably achieved when the food supply can continue irrespective of season, climate or distant conflict. Urban gardens partly rectify this discord between urbanization and a genuinely varied diet, replaced by purported variety where the same basic commodity is presented in many different forms (e.g., wheat grains such as bread, breakfast cereal of various kinds, pasta and baked goods). However, diversified processing may 'dilute out' health adverse techniques. The health benefits of a diversified diet relate in part to the environmental integrity, which the required biodiversity provides, in part to minimizing adverse factors, which may exceed acceptable thresholds in a narrow diet, and to the need for the wide spectrum of food components, macronutrients, micronutrients and phytochemicals, which Homo sapiens' physiology requires. Whilst most food diversity is attributable to plant sources, animal sources often provide significant nutritional security (e.g., fish and eggs for vitamin D, fish for n-3 fatty acids, lean meat for iron and zinc and in readily assimilable forms). Food diversity assumes greater importance with aging populations as their physical activity usually (if not necessarily) declines and the required food component diversity of the diet increases correspondingly. There are ways in which the required food diversity (probably 20-30 biologically different distinct foods over the course of a week) can be reduced. This is by the inclusion of more food component dense foods--like fish, lean meat, eggs, seeds and nuts. Not only does food diversity have relevance in a public health and food policy sense, but also in individual counseling in clinical practice. Assessment of a patient's food variety can be rapid and semi-quantitative, encouraging small and consequential changes in diet. When ethnicity is taken into account, in the clinical setting, this process can be even more rewarding for the practitioner and patient.     

Impact of Parental Food Choices on Child Food Neophobia

This study examined the impact of parental food choices on children's willingness to try new foods. The participants were 33 students in Grades 5 and 6 in one public school in Cincinnati, Ohio. One parent per student completed the Food Neophobia Scale (FNS) and food records. Outcome measures included (a) FNS scores for both parents and children, and (b) Healthy Eating Index (HEI) scores and number of different foods consumed by parents only. Parent-child FNS scores were significantly correlated. Negative associations occurred between the parent HEI fruit score and the child FNS score and the number of different foods consumed by the parent and the child FNS score. Findings suggest that parental food choices influence children's responses to new foods.     

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。     

Diet Quality and Dietary Diversity in France: Implications for the French Paradox

Objectives Assessing the quality of the total diet is a relatively new focus of studies in nutritional epidemiology. New indexes of healthful eating patterns have been largely limited to US populations. This study used evaluative criteria developed in the United States to assess diet quality and dietary diversity of French adults.Methods Habitual dietary intakes of a representative sample of 837 adults (361 men and 476 women) in the Val-de-Marne Departement were evaluated. Evaluative measures of diet quality included a modified diet quality index (DQI), a dietary diversity (DD) score, and a dietary variety score (DVS). The 5-point DQI assessed compliance with the key guidelines of the US Department of Agriculture (USDA) for healthy people. The DD score counted the number of major food groups consumed whereas the DVS counted the total number of foods consumed on a regular basis.Results Few French adults consumed diets consistent with the USDA dietary recommendations. Only 14% of respondents derived less than 30% of energy from fat and only 4% derived less than 10% of energy from saturated fat. As a result, 63% of the sample had DQI scores of either 0 or 1. In contrast, close to 90% of respondents scored a maximum of 5 in DD. Persons whose diets met US dietary recommendations also had the lowest DVSs.Conclusions Methodologic factors and cultural biases may account for some of the observed differences between French and US data. Nevertheless, studies of diet quality and diversity are a promising new approach to the study of the total diet and associated health outcomes and may provide new insight into the French paradox. J Am Diet Assoc. 1996; 96:663–669.     

Concept of a nutritious food: toward a nutrient density score

The American diet is said to be increasingly energy-rich but nutrient-poor. To help improve the nutrient-to-energy ratio, the 2005 Dietary Guidelines for Americans recommend that consumers replace some foods in their diets with more nutrient-dense options. Such dietary guidance presupposes the existence of a nutrient density standard. However, a review of the literature shows that the concept of a nutritious food is not based on any consistent standards or criteria. In many cases, healthful foods are defined by the absence of problematic ingredients-fat, sugar, and sodium-rather than by the presence of any beneficial nutrients they might contain. Past attempts to quantify the nutrient density of foods have been based on a variety of calories-to-nutrient scores, nutrients-per-calorie indexes, and nutrient-to-nutrient ratios. The naturally nutrient rich (NNR) score, which is based on mean percentage daily values (DVs) for 14 nutrients in 2000 kcal food, can be used to assign nutrient density values to foods within and across food groups. Use of the NNR score allows consumers to identify and select nutrient-dense foods while permitting some flexibility where the discretionary calories are concerned. This approach has implications for food labeling, nutritional policy making, and consumer education. The Food and Drug Administration has considered approving nutrient claims based on the ratio of a beneficial nutrient to the food's energy content, as opposed to a specified minimum amount of a nutrient per serving size. Given the current dietary trends, the nutrient density approach can be a valuable tool for nutrition education and dietary guidance.     

The effects of variety in food choices on dietary quality

The purpose of this study was to examine the effects of overall dietary variety, variety among major food groups, and variety within major food groups on dietary quality. Nutritional adequacy, one aspect of dietary quality, was measured by a Mean Adequacy Ratio (MAR)--an index of the percent of recommended intake for 11 nutrients. Other dietary quality measures included the percent of calories from fat and sugar and total intakes of energy, cholesterol, and sodium. A study sample of 3,701 individuals was selected from USDA's 1977-78 Nationwide Food Consumption Survey, excluding pregnant and lactating women and children under 1 year of age. Multiple regression analyses were performed to examine the relationships between each type of variety and each diet quality measure, controlling for age, sex, the number of foods, and all of their two-way interactions with variety. The variety terms added a significant increment to the variation in MAR that was explained by each of the models. Variety among five major food groups explained as much of the variation in MAR as did variety within those groups. Thus, dietary variety might best be defined as simply including foods from each of the major groups. Increases in this type of variety were associated with greater increases in MARs for females than for males and for persons with lower vs. higher numbers of foods. None of the types of variety could account for a sizeable proportion of the variation in the intakes of energy, fat, sugar, sodium, or cholesterol. That is, those measures were not related in any appreciable way to variety per se--either to the expansion or to the restriction of food choices. The key to limiting the intake of those constituents may be to selectively alter the scope of food choices to include more of some foods and less of others.     

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.