Operationalizing dietary diversity: a review of measurement issues and research priorities.

By M. Ruel. Journal of NutriLife, 2003

1,014 citations recorded by the source corpus.

Dietary diversity (DD) is universally recognized as a key component of healthy diets. There is still, however, a lack of consensus on how to measure and operationalize DD. This article reviews published literature on DD, with a focus on the conceptual and operational issues related to its measurement in developing countries. Findings from studies of the association between DD and individual nutrient adequacy, child growth and/or household socioeconomic factors are summarized. DD is usually measured using a simple count of foods or food groups over a given reference period, but a number of different groupings, classification systems and reference periods have been used. This limits comparability and generalizability of findings. The few studies that have validated DD against nutrient adequacy in developing countries confirm the well-documented positive association observed in developed countries. A consistent positive association between dietary diversity and child growth is also found in a number of countries. Evidence from a multicountry analysis suggests that household-level DD diversity is strongly associated with household per capita income and energy availability, suggesting that DD could be a useful indicator of food security. The nutritional contribution of animal foods to nutrient adequacy is indisputable, but the independent role of animal foods relative to overall dietary quality for child growth and nutrition remains poorly understood. DD is clearly a promising measurement tool, but additional research is required to improve and harmonize measurement approaches and indicators. Validation studies are also needed to test the usefulness of DD indicators for various purposes and in different contexts.

Subfields: Nutrition and Dietetics, Public Health, Environmental and Occupational Health

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Citations in the corpus

Farm production diversity and dietary quality: linkages and measurement issues (2018, methodology): “These scores are generally accepted as good and easy-to-measure proxies for the household’s economic access to food (Ruel 2003; Swindale and Bilinsky 2006; Headey and Ecker 2013).”
Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era (2014, background): “Energy-dense starchy staples, such as cereals, roots, and tubers, have only small amounts of bioavailable protein and micronutrients, leaving those consuming large amounts of them vulnerable to nutrient deﬁciencies (Arimond et al ., 2010; Ruel, 2003).”
What do we really know? Metrics for food insecurity and undernutrition (2011, background): “…of different food groups consumed by households (food variety score) has been proposed as a good indicator of nutritional status and even of food security more generally, but questions remain on advantages and drawbacks of such dietary diversity measures in particular 22 situations (Ruel, 2003).”
Improving diets with wild and cultivated biodiversity from across the landscape (2015, background): “Evidence linking dietary diversity to energy and micronutrient adequacy, and to child growth is now well established (Ruel 2003; Arimond and Ruel 2004; Arimond et al. 2010; Kennedy et al. 2011).”
Crop diversification, dietary diversity and agricultural income: empirical evidence from eight developing countries (2014, background): “Dietary diversity is often used as a food security proxy in nutrition surveys, and it generally has been found to be closely correlated to both caloric adequacy (the amount of kilocalories consumed) and anthropometric outcomes (Ruel 2006; Moursi et al. 2008; Tasciotti 2006).”
The importance of vegetables in ensuring both food and nutritional security in attainment of the Millennium Development Goals (2011, methodology): “Dietary Diversity Scores can be used as a food and nutritional security indicator (Ruel 2003; WHO 2010c), whereas the current policy of supplementation promulgated by international donor agencies, in which vitamin pills are provided by medical practitioners for the first 1,000 days of an infant’s…”
Women’s Empowerment in Agriculture: What Role for Food Security in Bangladesh? (2014, neutral): “(ii) Household dietary diversity One of the criticisms of the use of calorie availability indicators is that they do not reflect the quality of foods available to households (Ruel, 2003).”
Agricultural Production, Dietary Diversity and Climate Variability (2014, neutral): “Household dietary diversity is strongly associated with household calorie availability (Ruel, 2003), an important component of nutritional status, while diet composition is associated with the consumption of particular micronutrients as well as diet quality.”
Urban agriculture, poverty, and food security: empirical evidence from a sample of developing countries. (2010, background): “Dietary diversity is often used as a food security proxy in nutrition surveys, and has been generally found to be closely correlated to both caloric adequacy (the amount of kilocalories consumed) and anthropometric outcomes (for a review see Ruel (2006)).”
Production diversity and dietary diversity in smallholder farm households (2015, methodology): “Dietary diversity is usually measured using two indicators: the food variety score and the dietary diversity score (6, 7, 38, 39).”
Can Mobile Phones Improve Gender Equality and Nutrition? Panel Data Evidence from Farm Households in Uganda (2017, background): “Nutrition outcomes can be measured in different ways, including anthropometric indicators, food consumption based measures, and households’ subjective assessments of food access (Ruel, 2003; Masset et al., 2012; Shiferaw et al. 2014; Kabunga et al., 2014; Chiputwa and Qaim, 2016).”