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Nutrition and Health (including climate and ecological aspects)

Minimum dietary diversity in Mexico: establishment of cutoff point to predict micronutrients adequacy

European Journal of Clinical Nutrition volume 76, pages 739–745 (2022)Cite this article

Subjects

Abstract

Objective

To establish the cutoff point for a Minimum Dietary Diversity (MDD) that most accurately predicts the Mean Probability Adequacy (MPA) of 11 micronutrients in the Mexican population, and estimate the population prevalence above it.

Subjects and methods

We analyzed a 24 h-recall collected in a sample of 10,087 participants (≥1-year-old) from the 2012 Mexican National Health and Nutrition Survey. Foods were classified into ten food group indicators (FGIs) of the Food Agriculture Organization (FAO). The cutoff points of MDD were established as follows: (1) sum of the number of FGIs in the participant’s diet; (2) micronutrient intake adequacy estimated by the probability approach method of the FAO; (3) Receiver operating characteristic curves generated by age groups to assess the performance of the number FGIs consumed in predicting the MPA.

Results

The cutoff points of MMD established by age groups were: ≥4 FGIs in preschool-aged children (75.94% of sensitivity and 72.55% of specificity); ≥5 FGIs in school-aged children (60.51% of sensitivity and 72.82% of specificity) and adolescents (70.01% of sensitivity and 59.38% of specificity); and six in adults (62.26% of sensitivity and 70.33% of specificity) and elders (66.67% of sensitivity and 73.33% of specificity). Based on these cutoff points, we observed that 75% of the preschool-aged children, ~60% of school-aged children and adolescents, and less than 40% of adults and elders were above the MDD.

Conclusion

This study provides novel insight into the specific MDD cutoff point to predict micronutrient adequacy in the Mexican population.

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Fig. 1: Receiver operating characteristics curves for cutoff points of Minimum Dietary Diversity as predictors of Mean Probability Adequacy by age group among Mexican population aged ≥1-year-old (ENSANUT 2012).

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References

  1. WHO. Micronutrients. 2020. Available from: https://www.who.int/health-topics/micronutrients#tab=tab_1. Accessed May 2020.

  2. Hong Nguyen P, Huybregts L, Sanghvi TG, Mai Tran L, Frongillo EA, Menon P, et al. Dietary Diversity Predicts the Adequacy of Micronutrient Intake in Pregnant Adolescent Girls and Women in Bangladesh, but Use of the 5-Group Cutoff Poorly Identifies Individuals with Inadequate Intake. J Nutr. 2018;148:790–7.

    Article  Google Scholar 

  3. Rahmannia S, Diana A, Luftimas DE, Gurnida DA, Herawati DMD, Houghton LA, et al. Poor dietary diversity and low adequacy of micronutrient intakes among rural Indonesian lactating women from Sumedang district, West Java. PLoS ONE. 2019; https://doi.org/10.1371/journal.pone.0219675.

  4. Kassebaum NJ. The global burden of anemia. Clin Hematol/Oncol Clin. 2016;30:247–308.

    Article  Google Scholar 

  5. Bailey RL, West KP, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66:22–33. Suppl 2

    Article  CAS  Google Scholar 

  6. Ramakrishnan U. Prevalence of micronutrient malnutrition worldwide. Nutr Rev. 2002;60:S46–52. suppl_5

    Article  Google Scholar 

  7. Pedroza-Tobías A, Hernández-Barrera L, López-Olmedo N, García-Guerra A, Rodríguez-Ramírez S, Ramírez-Silva I, et al. Usual vitamin intakes by Mexican populations. J Nutr. 2016;146:1866S–1873S.

    Article  Google Scholar 

  8. Sánchez-Pimienta TG, López-Olmedo N, Rodríguez-Ramírez S, García-Guerra A, Rivera JA, Carriquiry AL, et al. High prevalence of inadequate calcium and iron intakes by Mexican population groups as assessed by 24-hour recalls. J Nutr. 2016;146:1874S–1880S.

    Article  Google Scholar 

  9. Batis C, Aburto TC, Sánchez-Pimienta TG, Pedraza LS, Rivera JA. Adherence to dietary recommendations for food group intakes is low in the Mexican population. J Nutr. 2016;146:1897S–1906S.

    Article  CAS  Google Scholar 

  10. Gaona‐Pineda EB, Rodriguez‐Ramirez S, Martinez‐Tapia B, Valenzuela‐Bravo DG, Gomez‐Acosta LM, Shamah‐Levy T. Dietary diversity in mexican adolescents from a 2016 national survey. FASEB J. 2017;31:643.25–643.25.

    Google Scholar 

  11. Gómez‐Acosta L, Gaona-Pineda EB, Rodríguez-Ramírez S, Martinez-Tapia B, Valenzuela-Bravo DG, Shamah-Levy T. Dietary diversity in Mexican preschool children: data from National Nutrition and Health Surveys in 2016. FASEB J. 2017;31:643–26.

    Google Scholar 

  12. Habte TY, Krawinkel M. Dietary diversity score: a measure of nutritional adequacy or an indicator of healthy diet? J Nutr Heal Sci. 2016;3:303.

    Google Scholar 

  13. Mak T-N, Angeles-Agdeppa I, Lenighan YM, Capanzana MV, Montoliu I. Diet diversity and micronutrient adequacy among Filipino school-age children. Nutrients 2019;11:2197.

    Article  CAS  Google Scholar 

  14. Kennedy G, Ballard T, Dop MC [Guide to measure dietary diversity at household and individual levels]. Food and Agriculture Organization; 2013. http://www.fao.org/3/i1983s/i1983s.pdf.

  15. Caswell BL, Talegawkar SA, Siamusantu W, West KP, Palmer AC. A 10-food group dietary diversity score outperforms a 7-food group score in characterizing seasonal variability and micronutrient adequacy in rural Zambian children. J Nutr. 2018;148:131–40.

    Article  Google Scholar 

  16. Arimond M, Wiesmann D, Becquey E, Carriquiry A, Daniels MC, Deitchler M, et al. Simple food group diversity indicators predict micronutrient adequacy of women’s diets in 5 diverse, resource-poor settings. J Nutr. 2010;140:2059S–2069S.

    Article  CAS  Google Scholar 

  17. Martin-Prével Y, Allemand P, Wiesmann D, Arimond M, Ballard T, Deitchler M, et al. Moving forward on choosing a standard operational indicator of women’s dietary diversity. FAO; 2015. http://www.fao.org/3/i4942e/i4942e.pdf.

  18. Romero-Martínez M, Shamah-Levy T, Franco-Núñez A, Villalpando S, Cuevas-Nasu L, Gutiérrez JP, et al. Encuesta Nacional de Salud y Nutrición 2012: diseño y cobertura. Salud Publica Mex. 2013;55:S332–S340. Supp 2

    Article  Google Scholar 

  19. Barquera S, Campos-Nonato I, Hernández-Barrera L, Pedroza A, Rivera-Dommarco J. Prevalencia de obesidad en adultos mexicanos, 2000-2012. Salud Publica Mex. 2013;55:S151–60.

    Article  Google Scholar 

  20. Lopez-Olmedo N, Carriquiry AL, Rodríguez-Ramírez S, Ramírez-Silva I, Espinosa-Montero J, Hernández-Barrera L, et al. Usual intake of added sugars and saturated fats is high while dietary fiber is low in the Mexican population. J Nutr. 2016;146:1856S–1865S.

    Article  CAS  Google Scholar 

  21. Conway JM, Ingwersen LA, Vinyard BT, Moshfegh AJ. Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women. Am J Clin Nutr. 2003;77:1171–8.

    Article  CAS  Google Scholar 

  22. Ramírez-Silva I, Rodríguez-Ramírez S, Barragán-Vázquez S, Castellanos-Gutiérrez A, Reyes-García A, Martínez-Piña A, et al. Prevalence of inadequate intake of vitamins and minerals in the Mexican population correcting by nutrient retention factors, Ensanut 2016. Salud Publica Mex. 2020;62:521–31.

    Article  Google Scholar 

  23. Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22:936–41.

    Article  Google Scholar 

  24. World Health Organization. Indicators for assessing infant and young child feeding practices: Part 1 Definitions. 2008. https://apps.who.int/iris/bitstream/handle/10665/43895/9789241596664_eng.pdf?sequence=1. Accessed Apr 2020.

  25. Iowa State University. Software for Intake Distribution Estimation. 2003. http://www.side.stat.iastate.edu/pc-side.php. Accesed Jan 2020.

  26. Rivera J, Hotz C, Rodríguez S, García A, Pérez A, Martínez H, et al. In: Bourges H, Casanueva E, Rosado JL (eds). [Nutrient Intake recommendations for the Mexican population, Physiological Bases.] 1st ed. Editorial Médica Panamericana; Mexico City, Mexico, 2008. pp 245–64.

  27. Institute of Medicine 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. https://doi.org/10.17226/13050.

  28. Institute of Medicine 1998. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: The National Academies Press. https://doi.org/10.17226/6015.

  29. Institute of Medicine 2000. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: The National Academies Press. https://doi.org/10.17226/9810.

  30. Otten JJ, Hellwing JP, Meyers Linda D (eds). Dietary reference intakes: the essential guide to nutrient requirements. National Academies Press; Washington, DC, 2006. https://www.nal.usda.gov/sites/default/files/fnic_uploads/DRIEssentialGuideNutReq.pdf.

  31. Trumbo P, Yates A, Schlicker S, Poos M. Dietary reference intakes Vitamin A, Vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. J Acad Nutr Dietetics. 2001;101:294–301.

    CAS  Google Scholar 

  32. Venegas-Aviles Y, Rodríguez-Ramírez S, Monterrubio-Flores E, García-Guerra A. Sociodemographic factors associated with low intake of bioavailable iron in preschoolers: National Health and Nutrition Survey 2012, Mexico. Nutr J. 2020;19:1–10.

    Article  Google Scholar 

  33. Tucker LA. Consumption of nuts and seeds and telomere length in 5,582 men and women of the National Health and Nutrition Examination Survey (NHANES). J Nutr Heal Aging 2017;21:233–40.

    Article  CAS  Google Scholar 

  34. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447–92.

    Article  Google Scholar 

  35. Jimenez-Aguilar A, Gaona-Pineda EB, Mejía-Rodríguez F, Gómez-Acosta LM, Méndez-Gómez Humarán I, Flores-Aldana M. Consumption of fruits and vegetables and health status of Mexican children from the national Health and nutrition survey 2012. Salud Publica Mex. 2014;56:S103–12.

    Article  Google Scholar 

  36. Meng L, Wang Y, Li T, van Loo-Bouwman CA, Zhang Y, Szeto IMY Dietary diversity and food variety in chinese children aged 3–17 years: Are they negatively associated with dietary micronutrient inadequacy? Nutrients. 2018; https://doi.org/10.3390/nu10111674.

  37. Cano-Ibáñez N, Gea A, Martínez-González MA, Salas-Salvadó J, Corella D, Zomeño MD, et al. Dietary diversity and nutritional adequacy among an older Spanish population with metabolic syndrome in the PREDIMED-plus study: A cross-sectional analysis. Nutrients. 2019; https://doi.org/10.3390/nu11050958.

  38. Gibson RS, Charrondiere UR, Bell W. Measurement errors in dietary assessment using self-reported 24-hour recalls in low-income countries and strategies for their prevention. Adv Nutr Int Rev J 2017;8:980–91.

    Article  Google Scholar 

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Funding

This research was funded by Bloomberg Philanthropies.

Author information

Authors and Affiliations

  1. Center for Nutrition and Health Research, National Institute of Public Health, Avenida Universidad 655 Colonia Santa María Ahuacatitlán, Cuernavaca, CP, 62100, Mexico

    Sonia Rodríguez-Ramírez, Tania G. Sánchez-Pimienta & Joaquín A. Marrón-Ponce

  2. CONACYT-Center for Nutrition and Health Research, National Institute of Public Health, Avenida Universidad 655 Colonia Santa María Ahuacatitlán, Cuernavaca, CP, 62100, Mexico

    Carolina Batis

  3. University of Antioquia, School of Nutrition and Dietetics, UdeA Calle 70 No. 52-21, Medellín, ANT, Colombia

    Gustavo Cediel

Authors
  1. Sonia Rodríguez-Ramírez
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  3. Carolina Batis
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  4. Gustavo Cediel
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  5. Joaquín A. Marrón-Ponce
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Contributions

CB and GC planned the study. SRR prepared the draft of the manuscript. JAMP conducted the analysis of food and micronutrient intake under the supervision of TGSP and SRR. JAMP had primary responsibility for the final content of the manuscript. All authors participated in the revision and the finalization of the manuscript.

Corresponding author

Correspondence to Joaquín A. Marrón-Ponce.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Informed consent from all adults and parents of participants under 18 years old and informed assent for participants between five and 17 years old was obtained before the information was collected. The ENSANUT 2012 protocol was approved by the INSP Research, Ethics, and Biosafety Committees.

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Rodríguez-Ramírez, S., Sánchez-Pimienta, T.G., Batis, C. et al. Minimum dietary diversity in Mexico: establishment of cutoff point to predict micronutrients adequacy. Eur J Clin Nutr 76, 739–745 (2022). https://doi.org/10.1038/s41430-021-01007-z

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