Rationale and definition:
Measuring dietary energy supply alone is an incomplete and insufficient metric to address the increasing burden of malnutrition globally; dietary diversity is a critical and complementary metric. Lack of dietary diversity has been shown to be a crucial issue, particularly in the developing world where diets consist mainly of starchy staples with less access to nutrient-rich sources of food such as animal protein, fruits and vegetables. Women and children are particularly vulnerable to ill effects.
This indicator tracks dietary diversity, a vital element of diet quality, by measuring the consumption of a variety of foods across and within food groups, and across different varieties of specific foods, to ensure adequate intake of essential nutrients and important non-nutrient factors. Research has demonstrated a strong association between dietary diversity and diet quality, and nutritional status of children.1 It is also clear that household dietary diversity is a sound predictor of the micronutrient density of the diet, particularly for young children.2 Studies have also shown that dietary diversity is associated with food security and socioeconomic status, and links between socioeconomic factors and nutrition outcomes are well known.3
Based on surveys, the indicator measures consumption of at least five of ten food groups: starchy foods; beans and peas; nuts and seeds; dairy; flesh foods; eggs; vitamin A-rich dark green leafy vegetables; other vitamin A-rich vegetables and fruits; other vegetables; and other fruits. The FAO, the Food and Nutrition Technical Assistance III Project (FANTA), and many other stakeholders have endorsed this indicator (under the name “Minimum Dietary Diversity – Women (MDD-W)”). This indicator helps practitioners set nutrition targets for women, advocate for healthier diets, and assess consumption patterns in order to improve women’s nutrition.4
This indicator can be disaggregated by age, household income, education, and urban/rural.
Comments and limitations:
The MDD-W has been piloted in several countries through household surveys (DHS) and individual research projects with the aim of widespread application as a global indicator by 2017; however, additional work will be needed to take this indicator to the global level. Further, while this indicator can be a useful proxy for diet quality of young children and women of reproductive age living in poverty in low-income countries, it does not take into account other aspects of diet that have been related to risk of NCDs, such as the adverse effects of refined starches, sugar, red meat, and trans fat, and might actually encourage over consumption of some unhealthy foods in other populations and demographic groups. Further, encouragement of higher consumption of some forms of animal flesh, especially beef and dairy products, could have adverse effects on sustainability if applied globally to all demographic groups.
To accurately understand and improve dietary quality worldwide, we need to begin to collect far more data on individual diets. Currently, many countries do not routinely collect dietary data, and those that do often do not capture robust data at the needed spatial and time scales. Further, new indicators of dietary quality should be developed that predict optimal health across the life cycle. Finally, a major weakness of this indicator is that it does not capture the nutritional status of an entire population. As data systems improve and we are able to collect high-quality dietary data in near real-time, diet quality indicators should be expanded to cover women and men starting at 6 months and going up to at least age 70.
Primary data source:
Potential lead agency or agencies:
See i) Arimond, M, and Ruel, MT (2004). Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. Journal of Nutrition 134 (10): 2579–2585. Ii) Kennedy, GL et al (2007). Dietary diversity score is a useful indicator of micronutrient intake in non-breast-feeding Filipino children. J Nutr 137, 472–477. iii) Rah, JH et al (2010). Low dietary diversity is a predictor of child stunting in rural Bangladesh. European Journal of Clinical Nutrition 64, 1393–1398.
Moursi, M, Arimond, M and Deweg, KG (2008). Dietary Diversity Is a Good Predictor of the Micronutrient Density of the Diet of 6- to 23-Month-Old Children in Madagascar. J. Nutr. 138: 2448-2453.
See i) Thorne-Lyman, AL et al (2010). Household dietary diversity and food expenditures are closely linked in rural Bangladesh, increasing the risk of malnutrition due to the financial crisis. J Nutr 140, 182S–188S. ii) World Bank (2006). Repositioning nutrition as central for development. World Bank. Washington, DC. iii) World Bank (2007). From agriculture to nutrition: Pathways synergies and outcomes. World Bank. Washington, DC.
See the Food and Nutrition Technical Assistance Project for more information.