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Dietary Diversity As a Measure of Women's Diet Quality

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Dietary Diversity As a Measure of Women's Diet Quality Dietary Diversity as a Measure of Women’s Diet Quality in Resource-Poor Areas: Results from Rural Bangladesh Site Mary Arimond, Liv Elin Torheim, Doris Wiesmann, Maria Joseph, Alicia Carriquiry March 2008 Food and Nutrition Technical Assistance Project (FANTA) Academy for Educational Development 1825 Connecticut Ave., NW Washington, DC 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 E-mail: [email protected] Website: www.fantaproject.org This study is made possible by the generous support of the American people through the support of the Office of Health, Infectious Disease, and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), under terms of Cooperative Agreement No. HRN-A-00-98-00046-00, through the FANTA Project, operated by the Academy for Educational Development (AED). The contents are the responsibility of AED and do not necessarily reflect the views of USAID or the United States Government. Published 2008 Recommended citation: Arimond, M., L. E. Torheim, D. Wiesmann, M. Joseph, and A. Carriquiry. Dietary Diversity as a Measure of Women’s Diet Quality in Resource-Poor Areas: Results from rural Bangladesh site. Washington, DC: Food and Nutrition Technical Assistance (FANTA) Project/Academy for Educational Development (AED), March, 2008. Copies of the publication can be obtained from: Food and Nutrition Technical Assistance Project Academy for Educational Development 1825 Connecticut Avenue, NW Washington, D.C. 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 Email: [email protected] Website: www.fantaproject.org TABLE OF CONTENTS Acknowledgments............................................................................................................................ i Acronyms........................................................................................................................................ ii Executive Summary.......................................................................................................................iii 1. Background................................................................................................................................. 1 2. Dietary diversity.......................................................................................................................... 2 3. Objectives ................................................................................................................................... 3 4. Bangladesh study: original research objectives and context...................................................... 4 5. Methods....................................................................................................................................... 6 5.1 Data collection for 24-hour recall and calculation of nutrient intakes................................ 6 5.2 Timing of repeat recalls ...................................................................................................... 6 5.3 Exclusions from the original sample................................................................................... 7 5.4 Development of analytic protocol....................................................................................... 8 5.5 Key nutrients....................................................................................................................... 9 5.6 Requirements and requirement distributions ...................................................................... 9 5.7 Food group diversity variables.......................................................................................... 10 5.8 A summary measure of diet quality: Mean probability of adequacy............................... 12 5.9 Summary of analytical approach and statistical methods................................................. 13 6. Results....................................................................................................................................... 15 6.1 Characteristics of women, and energy and macronutrient intakes ................................... 15 6.2 Description of dietary patterns.......................................................................................... 16 6.3 Micronutrient intake and food group diversity distributions ............................................ 19 6.4 Micronutrient intakes and probability of adequacy .......................................................... 19 6.5 Contributions of food groups to nutrient intakes .............................................................. 20 6.6 Relationship between diversity indicators and estimated intakes of individual micronutrients ................................................................................................................ 21 6.7 Relationship between energy from specific food groups and mean probability of adequacy ........................................................................................................................ 21 6.8 Relationship between diversity indicators and total energy intake................................... 22 6.9 Relationship between diversity indicators and mean probability of adequacy................. 22 6.10 Performance of diversity indicators using selected cutoffs for mean probability of adequacy ........................................................................................................................ 25 7. Summary and discussion........................................................................................................... 28 7.1 Dietary patterns................................................................................................................. 28 7.2 Micronutrient intakes and adequacy ................................................................................. 28 7.3 Relationships between food group diversity, diet quality, and energy intake .................. 29 7.4 Indicator performance....................................................................................................... 29 7.5 Preliminary implications for operationalizing food group diversity................................. 30 7.6 Generalizability................................................................................................................. 31 8. Conclusions............................................................................................................................... 32 References..................................................................................................................................... 33 Appendix 1: Tables for second observation day........................................................................... 36 Appendix 2. Women’s food group recall in DHS 5...................................................................... 41 Appendix 3: Estimated Average Requirements............................................................................ 43 Additional data tables and figures can be downloaded from the FANTA Project website at www.fantaproject.org/publications/bangladesh2007.shtml. Dietary Diversity as a Measure of Women’s Diet Quality in Resource-Poor Areas: Results from rural Bangladesh site ACKNOWLEDGMENTS This publication was made possible through the support provided to the Food and Nutrition Technical Assistance (FANTA) Project by the Office of Health, Infectious Disease and Nutrition of the Bureau for Global Health at the U.S. Agency for International Development, under terms of Cooperative Agreement No. HRN-A-00-98-00046-00 awarded to the Academy for Educational Development (AED). The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development. We would also like to acknowledge financial support for this project from the German Federal Ministry for Economic Cooperation and Development, the Norwegian Research Council, the International Food Policy Research Institute, and Iowa State University. We gratefully acknowledge the contributions of a group who joined us in meetings convened in Copenhagen (April 27-28, 2006), in conjunction with the Sixth International Conference on Dietary Assessment Methodology: Inge Brouwer Wageningen University, Netherlands Marie-Claude Dop Food and Agriculture Organization (FAO), Rome Elaine Ferguson University of Otago, New Zealand Yves Martin-Prével Institut de Recherche pour le Développement (IRD), Ouagadougou Marie Ruel International Food Policy Research Institute Suzanne Murphy Cancer Research Center of Hawaii Jeanne de Vries Wageningen University Lynne Wilkins Cancer Research Center of Hawaii We are grateful to Marie Ruel for providing early guidance in conceptualizing the study; the analytic protocol also developed from her earlier work with data from Kenya. In addition we thank Yisehac Yohannes and Wahid Quabili for providing background information on the data set and we thank Howarth Bouis and his research team for sharing these data. We are also grateful to Ali Subandoro and Yisehac Yohannes for their work on subsample selection and on tables, and to Jay Willis for helping finalize this document. Finally, we thank Lora Iannotti for useful comments on a previous draft. Any remaining errors are ours. i Dietary Diversity as a Measure of Women’s Diet Quality in Resource-Poor Areas: Results from rural Bangladesh site ACRONYMS AI Adequate intake AUC Area under the curve BLUP Best linear unbiased predictor BMI Body mass index BMR Basal metabolic rate CV Coefficient of variation DHS Demographic and Health Surveys EAR Estimated
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