Elsevier

The Journal of Nutrition

Volume 134, Issue 10, October 2004, Pages 2579-2585
The Journal of Nutrition

Dietary Diversity Is Associated with Child Nutritional Status: Evidence from 11 Demographic and Health Surveys1,2

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Simple indicators reflecting diet quality for young children are needed both for programs and in some research contexts. Measures of dietary diversity are relatively simple and were shown to be associated with nutrient adequacy and nutritional status. However, dietary diversity also tends to increase with income and wealth; thus, the association between dietary diversity and child nutrition may be confounded by socioeconomic factors. We used data from 11 recent Demographic and Health Surveys (DHS) to examine the association between dietary diversity and height-for-age Z-scores (HAZ) for children 6–23 mo old, while controlling for household wealth/welfare and several other potentially confounding factors. Bivariate associations between dietary diversity and HAZ were observed in 9 of the 11 countries. Dietary diversity remained significant as a main effect in 7 countries in multivariate models, and interacted significantly with other factors (e.g., child age, breast-feeding status, urban/rural location) in 3 of the 4 remaining countries. Thus, dietary diversity was significantly associated with HAZ, either as a main effect or in an interaction, in all but one of the countries analyzed. These findings suggest that there is an association between child dietary diversity and nutritional status that is independent of socioeconomic factors, and that dietary diversity may indeed reflect diet quality. Before dietary diversity can be recommended for widespread use as an indicator of diet quality, additional research is required to confirm and clarify relations between various dietary diversity indicators and nutrient intake, adequacy, and density, for children with differing dietary patterns.

Key words:

Demographic and Health Surveys (DHS)
dietary diversity
child nutritional status
diet quality
socioeconomic factors

Abbreviations:

DHS
Demographic and Health Surveys [The DHS program is funded by the U.S. Agency for International Development (USAID) and administered by ORC Macro. ORC Macro provides technical assistance to partner institutions in each country.]
HAZ
height-for-age Z-score(s)
LAC
Latin America/Caribbean
VIF
variance inflation factor
WHZ
weight-for height Z-score(s)

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1

Preliminary results were reported in Proceedings of the 2nd International Workshop, Ouagadougou, November 23–28, 2003 [Ruel, M. T. & Arimond, M. (2004) Dietary diversity and growth: an analysis of recent demographic and health surveys. In: Food Based Approaches for a Healthy Nutrition in West Africa (Brower, E. D., Traore, A. S. & Treche, S., eds.). University Press, Ouagadougou (in press)].

2

Funded in part by the Food and Nutrition Technical Assistance Project (FANTA) managed by the Academy for Educational Development for USAID.