Development of a dichotomous indicator for population-level assessment of dietary diversity in women of reproductive age

Yves Martin-Prevel*, Mary Arimond, Pauline Allemand, Doris Wiesmann, Terri J. Ballard, Megan Deitchler, Marie Claude Dop, Gina Kennedy, Anna Lartey, Warren T.K. Lee, Mourad Moursi, Elodie Becquey, Inge D. Brouwer, Alicia Carriquiry, Melissa C. Daniels, Nadia Fanou-Fogny, Elaine Ferguson, Maria L. Joseph, Marie T. Ruel, Liv Elin Torheim

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

58 Citations (Scopus)


Background: Dietary diversity is a key element of diet quality, but diets of women of reproductive age (WRA; aged 15-49 y) in resource-poor settings are often deficient in a range of micronutrients. Previous work showed associations between simple food-group diversity indicators (FGIs) and micronutrient adequacy among WRA. For operational and advocacy purposes, however, there is strong demand for a dichotomous indicator reflecting an acceptable level of dietary diversity. Objective: The aim of the study was to develop a dichotomous indicator of dietary diversity inWRA. Methods: We performed a secondary analysis of 9 data sets containing quantitative dietary data from WRA in resource-poor settings (total n = 4166). From the raw dietary data, we calculated an individual "mean probability of adequacy" (MPA) across 11 micronutrients. Several candidate FGIs were constructed. Indicator performance in predicting an MPA > 0.60 was assessed within each data set by using receiver-operating characteristic analysis and sensitivity and specificity analysis at various FGI cutoffs. The analysis was performed separately for nonpregnant and nonlactating (NPNL) women and for lactating women. Results: We identified 2 "best candidate" dichotomous indicators on the basis of 9- or 10-point food-group scores (FGI-9 and FGI-10) with a cutoff of ≥ 5 food groups. Both were significantly correlated to MPA in each site (P < 0.001). Areas under the curve were moderate, ranging from 0.62 to 0.82 among NPNL women and from 0.56 to 0.90 among lactating women. Comparisons of results slightly favored FGI-10 for all women. Conclusions: When resource-intensive dietary methods are not feasible, a simple dichotomous indicator based on a cutoff of ≥ 5 of 10 defined food groups reflects "minimum dietary diversity for women of reproductive age." According to the conclusions of a consensus meeting of experts, this indicator is well suited for population-level assessment, advocacy, and possibly also for tracking of change in dietary diversity across time.

Original languageEnglish
Article numbere001701
JournalCurrent Developments in Nutrition
Issue number12
Publication statusPublished - Dec 2017


  • Developing countries
  • Diet quality
  • Dietary diversity
  • Food groups
  • Indicator
  • Nutrition-sensitive interventions
  • Resource-poor settings
  • Women of reproductive age


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