Harmonising dietary datasets for global surveillance: methods and findings from the Global Dietary Database.

OBJECTIVE: The Global Dietary Database (GDD) expanded its previous methods to harmonise and publicly disseminate individual-level dietary data from nutrition surveys worldwide. DESIGN: Analysis of cross-sectional data. SETTING: Global. PARTICIPANTS: General population. METHODS: Comprehensive methods to streamline the harmonisation of primary, individual-level 24-h recall and food record data worldwide were developed. To standardise the varying food descriptions, FoodEx2 was used, a highly detailed food classification and description system developed and adapted for international use by European Food Safety Authority (EFSA). Standardised processes were developed to: identify eligible surveys; contact data owners; screen surveys for inclusion; harmonise data structure, variable definition and unit and food characterisation; perform data checks and publicly disseminate the harmonised datasets. The GDD joined forces with FAO and EFSA, given the shared goal of harmonising individual-level dietary data worldwide. RESULTS: Of 1500 dietary surveys identified, 600 met the eligibility criteria, and 156 were prioritised and contacted; fifty-five surveys were included for harmonisation and, ultimately, fifty two were harmonised. The included surveys were primarily nationally representative (59 %); included high- (39 %), upper-middle (21 %), lower-middle (27 %) and low- (13 %) income countries; usually collected multiple recalls/ records (64 %) and largely captured both sexes, all ages and both rural and urban areas. Surveys from low- and lower-middle v. high- and upper-middle income countries reported fewer nutrients (median 17 v. 30) and rarely included nutrients relevant to diet-related chronic diseases, such as n-3 fatty acids and Na. CONCLUSIONS: Diverse 24-h recalls/records can be harmonised to provide highly granular, standardised data, supporting nutrition programming, research and capacity development worldwide.

Minimum Dietary Diversity for Adolescents: Multicountry Analysis to Define Food Group Thresholds Predicting Micronutrient Adequacy among Girls and Boys Aged 10-19 Years.

Background: Adolescents' diets have been overlooked in nutrition information systems, interventions, and policies. The minimum dietary diversity for women (MDD-W) indicator has been validated to signal greater micronutrient adequacy among nonpregnant women from low- and middle-income countries, but there is limited evidence for valid food group thresholds among boys or nonpregnant nonlactating girls. Objective: To define a food group threshold that reflects minimum dietary diversity for adolescents. Methods: This multicountry study evaluated the test characteristics of a 10-point food group diversity score (FGDS)-underlying MDD-W-and food group thresholds to predict the micronutrient adequacy of diets from single 24-h recalls or food diaries (24-HRs) among 83,935 adolescents aged 10-19 y and repeated 24-HRs among 75,480 adolescents from upper-middle and high-income countries. Results: FGDS was lowest among adolescents in lower-middle countries (3.5 ± 1.1) and greatest in high-income countries (5.4 ± 1.3 points). Using single 24-HRs, 1-point increments in FGDS performed identically to predict a higher mean adequacy ratio among boys and girls (5.1 percentage points; 95% confidence interval: 5.0, 5.2; P < 0.001). MDD-W (i.e., ≥5 food groups) performed well in predicting a mean adequacy ratio of >0.60 among adolescents from upper-middle and high-income countries, whereas a ≥4 food group cutoff showed a superior balance between sensitivity, specificity, and percentage correctly classified in low (only girls) and lower-middle-income countries (boys and girls). In contrast, using repeated 24-HRs, the mean probability of adequacy levels among adolescents were too high and homogeneous (i.e., all mean probability of adequacies > 0.60) to define an optimal food group threshold. Conclusions: MDD-W can be extended to boys and girls aged 10-19 y from upper-middle and high-income countries. Furthermore, an adapted indicator using a ≥4 food group threshold signals higher micronutrient adequacy in low and lower-middle-income countries. Food group cutoffs to predict the micronutrient adequacy of usual intakes should be validated using repeated 24-HRs in populations where a lower proportion of adolescents meet mean dietary requirements.

The influence of recipe disaggregation in dietary assessment: results from the national food consumption survey in Saint Kitts and Nevis.

It is not always the case that recipe disaggregation is performed in dietary surveys. This investigation aimed to assess the influence of recipe disaggregation in the 2020-2021 national dietary survey in Saint Kitts and Nevis, and provide recommendations for future assessments. A total of 1,004 individuals provided information on their food consumption obtained using 24-h dietary recalls, and 442 recipes were reported. Some recipes were reported as single ingredients at the data collection stage (n = 65). In most cases, the respondent provided a standard recipe without disaggregation (n = 377). A simple and pragmatic recipe disaggregation methodology was developed. The procedure of recipe disaggregation comprised nine steps, including identifying recipes, ingredients, quantities, conversion factors, and the presence of visible fluid, among others. Seventy-eight non-disaggregated standard recipes were post-disaggregated (21% of recipes) to identify ingredient weights. Either the chi-square or Fisher's exact tests were applied to assess the significance of differences in frequency of food group consumption before and after disaggregation. The proportion of consumers across the different food groups increased dramatically for some food groups after recipe disaggregation, with significant differences (all p < 0.01) for cereals and their products (81.3% before and 94.7% after), eggs and their products (21.7% before and 34.6% after), fats and oils (6.9% before and 44.5% after), fish, shellfish and their products (26.7% before and 38.5% after), meat and meat products (59.7% before and 71.4% after), milk and milk products (30.4% before and 46.1% after), pulses, seeds, nuts and their products (18.6% before and 49.2% after), spices and condiments (34.0% before and 68.5% after, and vegetables and their products (49.9% before and 76.6% after). Consequently, most of the reported intakes in grams were also influenced across all food groups. Recipes are an important source of food consumption, and their disaggregation should be carefully considered in dietary assessment.

Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries.

Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.