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Dietary Diversity As a Measure of the Micronutrient Adequacy of Women's TECHNICAL REPORT FANTA 2 FOOD AND NUTRITION TECHNICAL ASSISTANCE Dietary Diversity as a Measure of the Micronutrient Adequacy of Women’s Diets: Results from Metropolitan Cebu, Philippines Site Melissa C. Daniels December 2009 Food and Nutrition Technical Assistance II Project (FANTA-2) &() 1825 Connecticut Ave., NW Washington, DC 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 E-mail: fantaMAIL@FHIorg Website: www.fantaPROJECTorg Dietary Diversity as a Measure of the Micronutrient Adequacy of Women’s Diets: Results from Metropolitan Cebu, Philippines Site Melissa C. Daniels December 2009 Food and Nutrition Technical Assistance II Project (FANTA-2) FHI 360 1825 Connecticut Ave., NW Washington, DC 20009-5721 Tel: 202-884-8000 Fax: 202-884-8432 E-mail: fantamail@fhi360 .org Website: www.fantaproject .org This report is made possible by the Recommended Citation: generous support of the American people through the support of the Office of Daniels, Melissa C. Dietary Diversity as a Health, Infectious Disease, and Nutrition, Measure of the Micronutrient Adequacy Bureau for Global Health, United States of Women’s Diets: Results from Agency for International Development Metropolitan Cebu, Philippines Site. (USAID), under terms of Cooperative Washington, DC: Food and Nutrition Agreement No. GHN-A-00-08-00001-00, Technical Assistance II Project, FHI 360, through the Food and Nutrition Technical 2009. Assistance II Project (FANTA-2), managed by FHI 360. Contact information: Food and Nutrition Technical Assistance The contents are the responsibility of II Project (FANTA-2) FHI 360 and do not necessarily reflect FHI 360 the views of USAID or the United States 1825 Connecticut Avenue, NW Government. Washington, D.C. 20009-5721 Tel: 202-884-8000 Published December 2009 Fax: 202-884-8432 Email: [email protected] Website: www.fantaproject.org Dietary Diversity as a Measure of Women’s Diet Quality in Resource-Poor Areas: Results from Metropolitan Cebu, Philippines Site Table of Contents Foreword ........................................................................................................................................................ i Acknowledgements ....................................................................................................................................... ii Acronyms and Abbreviations ........................................................................................................................ iii Executive Summary ...................................................................................................................................... v 1. Background ............................................................................................................................................... 1 2. Dietary Diversity ........................................................................................................................................ 2 3. Objectives ................................................................................................................................................. 3 4. Cebu Longitudinal Health and Nutrition Survey: Original Research Objectives and Context .................. 4 5. Methods..................................................................................................................................................... 5 5.1. Data Collection for 24-Hour Recall and Calculation of Nutrient Intakes ......................................... 5 5.2. Exclusions from the Original Sample .............................................................................................. 6 5.3. Brief Protocol Summary ................................................................................................................... 6 5.4. Key Nutrients ................................................................................................................................... 6 5.5. Requirements and Requirement Distributions ................................................................................. 7 5.6. Food Group Diversity Indicators ...................................................................................................... 7 5.7. Summary of Analytic and Statistical Methods ................................................................................. 8 5.8. Challenges in Protocol Implementation ........................................................................................... 9 6. Results .................................................................................................................................................... 11 6.1. Characteristics of Women, and Energy and Macronutrient Intakes .............................................. 11 6.2. Description of Dietary Patterns ...................................................................................................... 12 6.3. Distributions of Micronutrient Intakes and Food Group Diversity Score ....................................... 13 6.4. Average Micronutrient Intakes and Probability of Adequacy ......................................................... 13 6.5. Contributions of Food Groups to Nutrient Intakes ......................................................................... 14 6.6. Relationship between Diversity Indicators and Estimated Intakes of Individual Micronutrients .... 15 6.7. Relationship between energy from specific food groups and Mean Probability of Adequacy ...... 15 6.8. Relationship between Diversity Indicators and Total Energy Intake ............................................. 16 6.9. Relationship between Diversity Indicators and Mean Probability of Adequacy ............................ 17 7. Summary and Discussion ....................................................................................................................... 20 7.1. Dietary Patterns ............................................................................................................................. 20 7.2. Micronutrient Intakes and Adequacy ............................................................................................. 20 7.3. Food Group Diversity in Relation to Diet Quality and Energy Intake ............................................ 21 7.4. Implications for Future Diversity Scores ........................................................................................ 22 7.5. Generalizability .............................................................................................................................. 22 8. Conclusions ............................................................................................................................................. 25 References .................................................................................................................................................. 26 Appendix 1. Tables and Figures, All Women .............................................................................................. 29 Appendix 2. Tables and Figures, Lactating Women ................................................................................... 71 Appendix 3. Tables and Figures, Non-Pregnant Non-Lactating Women .................................................. 113 Dietary Diversity as a Measure of Women’s Diet Quality in Resource-Poor Areas: Results from Metropolitan Cebu, Philippines Site Appendix 4. Tables from Second Observation Day .................................................................................. 155 Appendix 5. Women’s Food Group Recall in DHS 5 ................................................................................ 158 Appendix 6: Estimated Average Requirements ........................................................................................ 160 Text Tables Table A. Food Groups Summed in Diversity Indicators ............................................................................... 9 Table B. Mean Nutrient Intakes for Lactating Women in Two Philippine Samples .................................... 23 Text Figures Figure A. Mean Probability of Adequacy for 11 Micronutrients ................................................................... 14 Figure B. Median Total Energy Intake by Diversity Score Across Eight Diversity Indicators .................... 17 Figure C. Mean Probability of Adequacy by Diversity Score Across Eight Diversity Indicators ................. 18 Dietary Diversity as a Measure of Women’s Diet Quality in Resource-Poor Areas: Results from Metropolitan Cebu, Philippines Site Foreword This report is one in a series of technical reports produced under the Women’s Dietary Diversity Project (WDDP). The WDDP is a collaborative research initiative to assess the potential of simple indicators of dietary diversity to function as proxy indicators of the micronutrient adequacy of women’s diets in resource-poor areas. Work carried out under the WDDP includes the development of a standard analysis protocol and application of that protocol to five existing data sets meeting the analytic criteria established by the project. The data sets analyzed as part of the WDDP are from sites in Bangladesh, Burkina Faso, Mali, Mozambique and the Philippines. Comparative results across the five sites are presented in a summary report, which will be published in 2010: Mary Arimond, Doris Wiesmann, Elodie Becquey, Alicia Carriquiry, Melissa C. Daniels, Megan Deitchler, Nadia Fanou, Elaine Ferguson, Maria Joseph, Gina Kennedy, Yves Martin-Prével and Liv Elin Torheim. Dietary Diversity as a Measure of Women’s
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