Evaluation of a context-specific diet diversity score (DDS) for predicting micronutrient adequacy in 6–10-year-old rural Indian children

Abstract

Low diet diversity is the major contributor to micronutrient inadequacy among children, underscoring a need for a rapid assessment tool to assess micronutrient adequacy. This study aimed to (i) develop a context-specific diet diversity score (DDS) tool (ii) evaluate the performance of the DDS scoring system against mean probability of adequacy for 10 micronutrients, 5 biomarkers of micronutrient status and (iii) identify an optimal DDS cut-off by applying minimum portion size threshold to support its potential use as a practical screening tool. A cross-sectional study was conducted among 6–10-year-old children (n = 76) in two villages of Ghatkesar sub-district, Telangana. Portion sizes of commonly consumed fruits and vegetables were standardized. Data on household demographics, anthropometry, and biomarkers of micronutrient status were collected using a pretested questionnaire and standardized protocols. Three non-consecutive 24-hour-dietary-recalls were obtained using the weighment method. DDS was developed based on the nutrient content of consumed foods; minimum intake thresholds of 0.1 g, 5 g and 10 g was applied while scoring. Mean probability of adequacy (MPA) for 10 micronutrients was estimated using ICMR-EAR values. Correlations of DDS with MPA and biomarkers were examined, and sensitivity and specificity were assessed using ROC curves, considering MPA ≥ 70% as adequate. The DDS included 13 food groups. Mean DDS (5 g threshold) was 8.67 ± 1.50 and correlated significantly with MPA (r = 0.58), and hemoglobin (t = 2.07). A DDS-5 g cut-off of ≥10 predicted MPA > 70%, with an AUC of 0.89. The DDS showed good predictive performance for micronutrient adequacy, but requires further field validation before programmatic use