Dietary diversity scores can be improved through the use of portion requirements: an analysis in young Filipino children

Objectives: Early childhood malnutrition is a pressing international concern which dietary diversity scores (summary scores of food groups in the diet) may be helpful in addressing. We explored three current research needs surrounding diversity scores: the impact of portion size on score function, the relationship of scores to nutrient adequacy and density and the ability of scores to function as screening tools. Subjects/Methods: 1810 children, age 24 months. Cross sectional study of a birth cohort. Results: We evaluated two nine food group dietary diversity scores based on 0 and 10 g minimum food group requirements for their relationship to nutrient adequacy and nutrient density. Both scores were significantly correlated with nutrient adequacy and density and predicted statistically significant increases (P < 0.05) in the probability of adequacy for all nutrients. However, correlations and predicted increases were somewhat larger for the 10 g score. We also considered the sensitivity and specificity of each score for detecting low and high nutrient adequacy in the population. The 10 g cutoff improved score ability to predict low nutrient adequacy, and reduced the misclassification of subjects for all comparisons. Conclusions: This research suggests that the score without portion requirements reflects dietary adequacy, but when feasible, further refinement of diversity scores is desirable through the application of minimum portion requirements.