Factors Which May Limit the Value Of Dietary Diversity and its Association With Nutritional Outcomes in Preschool Children in High Burden Districts of India

Dietary diversity plays a critical role in infants as they need energy and nutrient dense foods for both physical and mental development. This study examines whether three dietary diversity indices validate against Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) and studies the relationship of dietary diversity with nutritional status of preschool children, in two districts of India: Wardha district in Maharashtra state and Koraput district in Odisha state. Methods and Study Design: Dietary diversity was calculated using: individual food scores calculated using 24 hour diet recall (FS24hr) data; household dietary diversity using Berry’s index (DDI) and food scores calculated using food frequency data (FSFFQ). Nutritional status was assessed by anthropometric indices. Results: It was observed that 42.7% of 1 to 5 years children were underweight, 38% stunted and 27.6% wasted across both locations. The dietary diversity was found to be relatively better in Wardha when compared with Koraput with mean diversity of FS24hr 7, DDI 90 and FSFFQ 63 in both locations. Preschool children in both locations consumed a cereal based diet. Apart from protein in both locations and energy in Koraput, the NAR of all nutrients consumed was <70% of requirement. MAR showed lower consumption of nutrients than the recommended levels (50% adequacy). NAR and MAR correlate with FS24hr indicating that dietary diversity calculated using 24 hour diet recall ensures nutrient adequacy but showed association only with Height-for-Age scores. Conclusion: Dietary diversity calculated using three methods did not show any correlation with nutritional status of 1 to 5 years children.