Dietary diversity as an indicator for nutrient adequacy and nutritional status among nonbreastfeeding 2 to 5 year old children in Mbooni division-kenya
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During recent years, considerable attention has been paid to global improvement of feeding of infants and young children in developing countries. Monitoring and evaluation of nutrition improvement programs in community settings is difficult because a full and accura~e assessment of the nutritional adequacy of diets is costly and time-consuming. Simple and ea~y to conduct t measure of dietary diversity scores has been thought to serve as a good indicator of nutrient adequacy. However, there is no conclusive evidence as research has shown contradicting results for different population groups. This study was designed to establish the relationship between dietary diversity score and adequacy of nutrient intake among non-breastfeeding children aged 2 to 5 years in a rural environment. A cross sectional study was carried out between October and December, 2007 in Mbooni division of Kenya. A sample of 75 non breastfeeding children was interviewed 3 times at an interval of between 2 to 11 days with their mothers/ caregivers as the respondents. The required information was collected using a 24-hour dietary recall method and a 24-hour dietary diversity questionnaire comprising 14 food groups. Energy, protein, vitamin A, iron and zinc were the nutrients considered and their adequacy and association with dietary diversity was assessed. Dietary Diversity Scores were developed to measure diet diversification, while nutrient adequacy ratio for each nutrient was calculated to reflect specific nutrient adequacies in the diet. Mean adequacy ratio of the micronutrients (vitamin A, iron, zinc) was calculated to reflect the overall micronutrient adequacy of the diets. Demographic characteristics of the households were recorded using a previously pretested structured questionnaire. Anthropometric measurements of weight and height of the children were taken and their age and sex recorded. Results were analysed using Statistical package for social sciences (SPSS version 12.0) and Epi-info softwares. Descriptive st~tistics, analysis of variance, t-test and correlations were performed and a P;0.05 was considered as statistically significant. The results revealed that the mean Dietary Diversity Scores ranged between 2 and 8 with a mean score of 4.3. The Mean Adequacy Ratio was 59.15 percent. Mean Adequacy Ratio, Energy, Protein, Vitamin A, iron and zinc correlated positively with Dietary Diversity Scores. However, except for energy all other correlations were not statistically significant at P::;0.05. Results indicate that there exists a positive relationship between dietary diversity and the nutrient adequacy of the children. Further results show that Dietary Diversity Scores do not significantly correlate with the nutritional status of the children. Dietary Diversity Score values of 2 and 3 were found to be the best cutoff points that satisfy child's requirements for protein and iron respectively. Consumption of all the food groups consumed by the non-breastfeeding children ranging from 2 to 8 does not satisfy vitamin A, zinc and energy requirements. In addition, mean adequacy ratio cutoff points cannot be developed for the population in this context as it conceals the inadequacy of vitamin A and zinc. While there is some association between 24 hour dietary diversity score and dietary intake of energy and nutrients, one cannot use a one-point cut-off to measure nutrient adequacy. Hence, mean adequacy ratio is a poor indicator of overall nutritional adequacy of the diet. Therefore, in order to fully utilize dietary diversity as an indicator of nutrient adequacy, this study recommends one to assess and develop cutoff points for individual nutrients in isolation. In addition, more validation studies evaluating nutrients not considered in this study need to be carried out in similar set-ups as well as in different seasons.