Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar.

This study was conducted in the context of a multicountry validation of indicators of diet quality and had the following objectives: 1) to determine how well dietary diversity scores (DDS) predict diet quality of children aged 6-23 mo in urban Madagascar; and 2) to assess whether the prediction was improved by changing the food groups included and by imposing a minimum amount restriction. Correlation and regression were used to describe the relationship between 4 diversity scores (2 based on 8 and 7 food groups, the latter excluding fats and oils, and 2 that imposed a 10-g minimum restriction on food groups) and the mean micronutrient density adequacy (MMDA) of the diet. MMDA, the dietary quality score used, was calculated as the mean individual micronutrient density adequacy for 9 or 10 "problem" nutrients (depending on age and breast-feeding status), each capped at 100%. We used sensitivity and specificity analysis to determine how well DDS predicted MMDA below or above selected cut-offs. All scores were positively correlated with MMDA. When the fats and oils group was omitted, correlations were 10-16% higher for breast-fed children and 19-28% higher for non-breast-fed children. Correlations were only slightly improved with the 10-g minimum. With the 7-food group score, a score of

Assessment of child feeding practices using a summary index: stability over time and association with child growth in urban Madagascar.

BACKGROUND: Previous studies investigating the association between an infant and child feeding index (ICFI) and length-for-age were based on a cross-sectional design and on the assumption that data collected with brief recalls could provide information about more enduring processes. OBJECTIVES: The objectives were to test the stability of the individual ICFI values over time and to investigate how they relate to length-for-age z score (LAZ) and weight-for-length z score (WLZ) at the end of the study. DESIGN: This prospective cohort study included 363 children aged 6-17 mo who were visited 3 times over 6 mo. A cross-sectional ICFI (CS-ICFI) was constructed for each visit by using data on feeding practices and data from quantitative 24-h recalls. A longitudinal ICFI (L-ICFI) was constructed with use of the 3 CS-ICFIs. The stability of the CS-ICFI was assessed by using the variance of the repeatability coefficient (s(2)r). RESULTS: Stability of the CS-ICFI was shown by the value of 0.704 (95% CI: 0.625, 0.805) of the s(2)r, which differed significantly from 1 (P < 0.0001). There was no significant association between the CS-ICFIs and LAZ or WLZ at visit 3. In contrast, when moving from low to high L-ICFI, there was a highly significant 0.5 z score difference in mean LAZ at visit 3 (P = 0.0008). The L-ICFI was not associated with WLZ. CONCLUSIONS: The ICFI constructed by using data collected with brief recalls can provide information about feeding in the long term. However, the absence of association with LAZ suggests a lack of precision that can be reduced by using an ICFI based on repeated measurements.