Review | Published:

Dietary diversity score and obesity: a systematic review and meta-analysis of observational studies

European Journal of Clinical Nutrition volume 70, pages 19 (2016) | Download Citation

Subjects

Abstract

Background/Objectives:

Studies examining the association between dietary diversity score (DDS) and obesity have led to inconsistent findings. Therefore, the purpose of this review is to summarize and elucidate the source of heterogeneous results reported in different studies.

Methods:

PubMed, ISI Web of Science, Scopus and Google Scholar were searched through December 2013 to identify all relevant articles. Sixteen publications met the inclusion criteria for the systematic review and 10 articles were entered into the meta-analysis. Eight studies had data on the odds ratio (OR) for overweight/obesity and eight compared the mean body mass index (BMI) among subjects with highest versus the lowest DDS.

Results:

A meta-analysis on eligible studies failed to show a significant association on either overweight/obesity OR (OR: 0.72; 95% confidence interval (CI): 0.45–1.16; P=0.174) or mean differences (MD) in BMI (MD: 0.22; 95% CI: −0.70–1.14; P=0.643) comparing the highest and lowest diverse diets. Between-study heterogeneity was high, and subgroup analysis failed to identify the source of heterogeneity.

Conclusions:

Our systematic review and meta-analysis showed that there was no significant association between DDS and BMI status, which may be due to use of different methods for assessing dietary intake and determination of DDS. Thus, well-designed prospective studies with similar approaches to assess DDS are highly recommended.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Obesity and overweight. World Health Organization . Updated March 2013.

  2. 2.

    , . Trends in underweight and overweight/obesity prevalence in Chinese Youth, 2004–2009. Int J Behav Med 2013; 21: 682–690.

  3. 3.

    , . Redefining type 2 diabetes: 'diabesity' or 'obesity dependent diabetes mellitus'? Obes Rev 2000; 1: 57–59.

  4. 4.

    , , , , , . Body mass index and risk of diabetes mellitus in the Asia-Pacific region. Asia Pac J Clin Nutr 2006; 15: 127–133.

  5. 5.

    , . Duration of obesity is a risk factor for non-insulin-dependent diabetes mellitus, not for arterial hypertension or for hyperlipidaemia. Acta Diabetol 1998; 35: 130–136.

  6. 6.

    , , , , . Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants. Int J Epidemiol 2004; 33: 751–758.

  7. 7.

    . Insulin resistance: the link between obesity and cardiovascular disease. Med Clin North Am 2011; 95: 875–892.

  8. 8.

    . [The metabolic syndrome: epidemiology and diagnosis]. Acta Med Austriaca 2004; 31: 130–132.

  9. 9.

    , , , . Weight change and incident metabolic syndrome in Iranian men and women; a 3 year follow-up study. BMC Public Health 2009; 9: 138.

  10. 10.

    , . Obesity as a major risk factor for cancer. J Obes 2013; 2013: 291546.

  11. 11.

    , , , , . Body mass index in childhood and adult risk of primary liver cancer. J Hepatol 2013; 60: 325–330.

  12. 12.

    , , , , , et al. Body size and prostate cancer: a 20-year follow-up study among 135006 Swedish construction workers. J Natl Cancer Inst 1997; 89: 385–389.

  13. 13.

    , , , , , et al. Obesity, energy balance, and cancer: new opportunities for prevention. Cancer Prev Res (Phila) 2012; 5: 1260–1272.

  14. 14.

    , , , . [Causes of obesity]. An Sist Sanit Navar 2002; 25: 17–27.

  15. 15.

    , . [Dietetic determinants on food intake and effects in body weight regulation]. Arch Latinoam Nutr 2003; 53: 243–250.

  16. 16.

    . Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 2002; 13: 3–9.

  17. 17.

    , , , , , et al. Unique dietary patterns and chronic disease risk profiles of adult men: the Framingham nutrition studies. J Am Diet Assoc 2005; 105: 1723–1734.

  18. 18.

    , , , , . Overall and within-food group diversity are associated with dietary quality in Belgium. Public Health Nutr 2010; 13: 1965–1973.

  19. 19.

    , , , . Dietary diversity score in adolescents - a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study. Asia Pac J Clin Nutr 2004; 13: 56–60.

  20. 20.

    , . Food variety and dietary diversity as indicators of the dietary adequacy and health status of an elderly population in Sharpeville, South Africa. J Nutr Elder 2008; 27: 101–133.

  21. 21.

    , . A comparison of three dietary pattern indexes for predicting biomarkers of diet and disease. J Am Coll Nutr 2005; 24: 294–303.

  22. 22.

    , . A cross-sectional baseline survey investigating the relationship between dietary diversity and cardiovascular risk factors in women from the Vaal Region, South Africa. J Nurs Educ Pract 2013; 4: p50.

  23. 23.

    , , , . Dietary diversity score and cardiovascular risk factors in Tehranian adults. Public Health Nutr 2006; 9: 728–736.

  24. 24.

    , , . Dietary diversity score is favorably associated with the metabolic syndrome in Tehranian adults. Int J Obes (Lond) 2005; 29: 1361–1367.

  25. 25.

    , , . Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study. J Am Coll Nutr 1995; 14: 233–238.

  26. 26.

    , . Dietary diversity score is related to obesity and abdominal adiposity among Iranian female youth. Public Health Nutr 2011; 14: 62–69.

  27. 27.

    , , , , , . High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores. BMC Public Health 2013; 13: 314.

  28. 28.

    , . Dietary energy density is favorably associated with dietary diversity score among female university students in Isfahan. Nutrition 2012; 28: 991–995.

  29. 29.

    , , , , , et al. The association of food security and dietary variety in subjects aged over 40 in District 13 of Tehran. Iranian Journal of Endocrinology and Metabolism 2012; 14: 360–368.

  30. 30.

    , , , , , et al. Comprehensive geriatric assessment of elderly highlanders in Qinghai, China IV: comparison of food diversity and its relation to health of Han and Tibetan elderly. Geriatr Gerontol Int 2009; 9: 359–365.

  31. 31.

    , , , . Fatness and overweight in women and children from riverine Amerindian communities of the Beni River (Bolivian Amazon). Am J Hum Biol 2007; 19: 61–73.

  32. 32.

    , , , , . Use of variety/diversity scores for diet quality measurement: relation with nutritional status of women in a rural area in Burkina Faso. Eur J Clin Nutr 2005; 59: 703–716.

  33. 33.

    , , , . Measuring dietary diversity in rural Burkina Faso: comparison of a 1-day and a 3-day dietary recall. Public Health Nutr 2007; 10: 71–78.

  34. 34.

    , , , , . Dietary diversity scores and nutritional status of women change during the seasonal food shortage in rural Burkina Faso. J Nutr 2006; 136: 2625–2632.

  35. 35.

    , , . Systematic Reviews in Health Care: Meta-analysis in context, 2nd ed. BMJ: London. pp xviii 487, 2001.

  36. 36.

    . An assessment of dietary diversity in six Nigerian states. Afr J Biomed Res 2010; 13: 161–167.

  37. 37.

    , , , , , . Are dietary diversity scores related to the socio-economic and anthropometric status of women living in an urban area in Burkina Faso? Public Health Nutr 2008; 11: 132–141.

  38. 38.

    , . Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–1558.

  39. 39.

    , , , . Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.

  40. 40.

    , , . A more diversified diet among Mexican men may also be more atherogenic. J Nutr 2006; 136: 2921–2927.

  41. 41.

    , , , , , et al. Modifiable socio-behavioural factors associated with overweight and hypertension among persons aged 35 to 60 years in eastern Uganda. PLoS One 2012; 7: e47632.

  42. 42.

    , , , , . A simple food quality index predicts mortality in elderly Taiwanese. J Nutr Health Aging 2011; 15: 815–821.

  43. 43.

    , , , , . Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr 1993; 57: 434–440.

  44. 44.

    , . Household food diversity and nutritional status among adults in Brazil. Int J Behav Nutr Phys Act 2011; 8: 22.

  45. 45.

    . Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr 2003; 133: 3911S–3926SS.

  46. 46.

    , , , , , et al. Variety in vegetable and fruit consumption and the risk of gastric and esophageal cancer in the European prospective investigation into cancer and nutrition. Int J Cancer 2012; 131: E963–E973.

Download references

Author information

Affiliations

  1. Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    • A Salehi-Abargouei
    • , F Akbari
    •  & L Azadbakht
  2. Department of Community Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran

    • A Salehi-Abargouei
    • , F Akbari
    •  & L Azadbakht
  3. Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    • A Salehi-Abargouei
  4. School of Nutrition, Ryerson University, Toronto, Ontario, Canada

    • N Bellissimo

Authors

  1. Search for A Salehi-Abargouei in:

  2. Search for F Akbari in:

  3. Search for N Bellissimo in:

  4. Search for L Azadbakht in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to L Azadbakht.

About this article

Publication history

Received

Revised

Accepted

Published

DOI

https://doi.org/10.1038/ejcn.2015.118

Further reading