Defining a dichotomous indicator for population-level assessment of dietary diversity among pregnant adolescent girls and women : a secondary analysis of quantitative 24-h recalls from rural settings in Bangladesh, Burkina Faso, India and Nepal

International audience ; BackgroundThe Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among non-pregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements.ObjectiveThis study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15-49 years in LMICs.MethodsWe used secondary quantitative 24-hour recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India and Nepal, total n=4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA >0.60.ResultsIn the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, while the proportion of pregnant women with an MPA >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), and very good specificity (81%) and percentage of correctly classified individuals (79%).ConclusionsThe WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15-49 years in LMICs. Moreover, the threshold of 5 or more food group for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiological status.