Validation of dietary diversity as indicator of micronutrient adequacy of diet of pregnant women at Jimma town south west Ethiopia

Abstract

Background: Micronutrient deficiencies among women are a global problem and are most severe for women in developing countries. Current methods used to assess micronutrient deficiencies primarily rely on biochemical diagnostic tests of blood or urine, which, although considered the gold standard, are often difficult, time consuming, and expensive to collect and analyze, and are thus not generally widely used in community settings for monitoring and evaluation of nutrition improvement programs. Therefore, validates these simpler measures of dietary diversity as proxy measures micro nutrient adequacy of diet is important Objective: To validate dietary diversity as indicator of micronutrient adequacy of diet of pregnant women in Jimma town southwest Ethiopia. Method: community based cross-sectional study design was conducted on pregnant women of 99 Sample sizes in Jimma town. Simple Random sampling technique was applied with structured questionnaire for socio demographic characteristic and quantitative interactive 24- hour recall for dietary intakes. Data were entered in to food processor software for nutrition analysis exports to Microsoft excel then into SPSS version 20.0 used for data analysis. For all statistical tests P -values < 0.05 considered significant. DDS was calculated and analysis of nutrient adequacy ratio of each selected micronutrient and mean adequacy ratio of nutrient were assessed the overall nutrient adequacy. Correlations between four food group indicators and MAR was assessed. Receiver operating curve (ROC) analysis was used to test the performance of each indicator as a predictor of MAR to determine the DDS cut-off point that give maximized sensitivity and specificity. Result: Pearson’s correlations between food group indicators and MAR indicate that r values range from (r=0.307-0.4260) were all highly significant with (p<0.0001). ROC analysis confirmed that the predictive power of the dietary diversity indicators with mean adequacy ratio (MAR) cutoff point summarized by the area under the curve (AUC) which was(AUC > 0.7 ) predictive power for all dietary diversity indicators and significant (P-value ≤0.001) . General from all five or above dietary diversity score of nine-food group and six or above dietary diversity score of 13-food group was the best cutoff to maximized sensitivity and specificity to measure micronutrient adequacy of pregnant women. Conclusion and recommendation: correlation between dietary diversity score and MAR was Positive and significant among pregnant women in study area. Therefore, study supports that use of simple dietary diversity indicators are promising tools for assessing the micronutrient adequacy of the diet among pregnant women. In furthermore validation of dietary diversity indicators against micronutrient adequacy at different study place and in different season needed to develop cutoff point at country level.