Dietary Diversity Score: A Measure of Nutritional Adequacy or an Indicator of Healthy Diet?

Abstract

At the time when the lack of indicators seemed to constrain appropriate child feeding in developing countries, dietary diversity score (DDS) emerged as a measure of nutritional adequacy that could close the gap. DDS refers to the number of food groups consumed in a given time, often in 24 hrs. Commonly, a diet of at least 4 DDS was valid as nutritionally adequate. Though validations with the test of correlation between DDS and nutrient adequacy ratio (NAR) or mean nutrient adequacy ratio (MAR) have been highly significant (p<0.001), the correlation coefficients in most cases were less than 0.5 indicating problems of deficiency. MAR cannot prove itself a true reference of nutrients adequacy because it stands for the mean ratio of all nutrients to recommended allowance of the nutrients, masking the real status of each nutrient. The differences in gender, age and physiology of the participants in the validation of DDS, the variability of nutrient density within food groups, and the neglect of food intake further complicate the accuracy of DDS as a measure of nutrient adequacy. It is true that dietary diversity increases the potential for the provision of different nutrients and healthy phytochemicals that satisfy the requirement for normal growth and health. It also contributes to the ecosystem services by its involvement in primary production, nutrient cycle, food provision and environmental regulation. These favorable characters and the contrasting problems of standardizing DDS as a measure of nutritional adequacy, call for a change that suggest to better use DDS as an indicator of healthy diet.