Determinants of underweight among lactating mothers in public health facilities, Siraro District, Southern Ethiopia: unmatched case-control study.

BACKGROUND: Ethiopia is reported to have one of the highest prevalence of underweight among lactating mothers in Africa. In our study setting, the nutritional report from the district health office showed a high number of underweight lactating mothers and recurrent malnutrition problems. However, the determinants of underweight among lactating mothers were not well understood in our study setting. The study aimed to assess the determinants of underweight among lactating mothers in public health facilities of Siraro District, Southern Ethiopia. METHODS: Unmatched case control study was conducted among 390 (130 cases and 260 controls) lactating mothers in public health facilities of Siraro District from April 30 to May 30/2022. Cases were lactating mothers with BMI < 18.5 kg/m2 and controls were mothers whose BMI was ≥ 18.5 kg/m2. To identify the determinants of underweight, bivariate and multivariable binary logistic regression analysis were carried out. The final model was interpreted using adjusted odds ratio (AOR), along with a 95% confidence interval (CI). Significance was declared at p-value < 0.05. RESULT: Multivariable logistic regression analysis revealed that having; antenatal care visits [AOR = 0.43, 95% CI (0.26,0.72)], latrine availability [AOR = 0.50,95% CI (0.27,0.93)], poor food consumption score [AOR = 5.40, 95% CI (3.15,9.27)], inadequate dietary diversity score [AOR = 1.66, 95% CI (1.20,2.78)], medium [AOR = 3.34, 95% CI (1.52,7.33)] and poor wealth index [AOR = 6.32, 95%CI(3.12,12.81)] were significantly associated with being underweight among lactating mothers. CONCLUSION: Antenatal care visits, latrine availability, poor food consumption scores, inadequate dietary diversity score, medium and poor wealth index were the determinants of underweight. A multi-sectoral approach focusing on latrine construction, economic empowerment and food diversification, as well as ongoing awareness creation, is essential to increase the nutritional status of lactating mothers and break the vicious cycle of malnutrition.

Dietary diversity and associated factors among infants and young children in three West African countries.

Providing children healthy diversified diets is important for their optimal growth and development. The high prevalence of under-nourishment during the critical early life period is of serious concern in West Africa. We assessed the level of dietary diversity and associated factors for children aged 6-23 months in Côte d'Ivoire, Niger and Senegal. Prior 24 h dietary intake was assessed for 3,528 children (Côte d'Ivoire: N = 118; Niger: N = 763; Senegal: N = 2,647) using the Diet Quality Questionnaire survey tool administered to primary caregivers. Cluster random sampling was conducted for urban and rural areas in Niger and Senegal and simple random sampling was used in Côte d'Ivoire, where only rural households were selected. Survey data were analyzed to determine children's intake of items from eight food groups: breast milk; grains, roots, tubers and plantains; pulses, nuts and seeds; dairy products; flesh foods; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Minimum Dietary Diversity (MDD) was assessed based on the consumption of ≥5 of the 8 food groups. In all countries, the majority of children were ≥ 12 months of age and from rural households. Children from poor/very poor households ranged from 32.4 to 41.9%. MDD prevalence was 54.2% in Côte d'Ivoire, 33.3% in Niger and 30.8% in Senegal. In all three countries, children 12-23 months had significantly higher consumption of six of the food groups, compared to those 6-11 months, and children ≥12 months had a higher likelihood of MDD, compared to infants, in Niger (aOR = 4.25; 95% CI: 2.46, 7.36) and Senegal (aOR = 2.69; 95% CI: 2.15, 3.35). MDD prevalence was higher among children in urban, compared to rural, areas in Niger (p = 0.020) and Senegal (p < 0.001) and significantly higher in the wealthiest, compared to poorest, households. This study suggests most young children in Côte d'Ivoire, Niger and Senegal are not receiving an adequately diversified diet, with a reliance on starchy staples and lower intake of high-quality protein sources. Our results highlight socio-economic barriers to attaining dietary diversity in these settings and stress the urgent and continuing need for investments in strategies that support optimal complementary feeding practices.

Association between dietary diversity changes and frailty among Chinese older adults: findings from a nationwide cohort study.

BACKGROUND: Dietary diversity has been suggested as a potential preventive measure against frailty in older adults, but the effect of changes in dietary diversity on frailty is unclear. This study was conducted to examine the association between the dietary diversity score (DDS) and frailty among older Chinese adults. METHODS: A total of 12,457 adults aged 65 years or older were enrolled from three consecutive and nonoverlapping cohorts from the Chinese Longitudinal Healthy Longevity Survey (the 2002 cohort, the 2005 cohort, and the 2008 cohort). DDS was calculated based on nine predefined food groups, and DDS changes were assessed by comparing scores at baseline and the first follow-up survey. We used 39 self-reported health items to assess frailty. Cox proportional hazard models were performed to examine the association between DDS change patterns and frailty. RESULTS: Participants with low-to-low DDS had the highest frailty incidence (111.1/1000 person-years), while high-to-high DDS had the lowest (41.1/1000 person-years). Compared to the high-to-high group of overall DDS pattern, participants in other DDS change patterns had a higher risk of frailty (HRs ranged from 1.25 to 2.15). Similar associations were observed for plant-based and animal-based DDS. Compared to stable DDS changes, participants with an extreme decline in DDS had an increased risk of frailty, with HRs of 1.38 (1.24, 1.53), 1.31 (1.19, 1.44), and 1.29 (1.16, 1.43) for overall, plant-based, and animal-based DDS, respectively. CONCLUSIONS: Maintaining a lower DDS or having a large reduction in DDS was associated with a higher risk of frailty among Chinese older adults. These findings highlight the importance of improving a diverse diet across old age for preventing frailty in later life.

Dietary diversity and its association with changes in anthropometric indices of community-dwelling older adults in Tehran, Iran: a longitudinal study (2017-2021).

BACKGROUND: Dietary diversity refers to the consumption of a variety of foods or food groups over a given reference period, which is crucial for improving nutrition and overall health. This longitudinal study aimed to investigate the association between dietary diversity and anthropometric indices in community-dwelling older adults living in Tehran in 2017 and 2021. METHODS: The current study was conducted on 368 older adults [204 (55.4%) women and 164 (44.6%) men] over 60 years of age living in Tehran, who were selected by a systematic cluster sampling method at two-time points, 2017 and 2021. Anthropometric measures (weight, height, hip circumference, and waist circumference) were assessed with standard methods. The participants' dietary intake was assessed by completing two non-consecutive 24-hour recalls, and dietary diversity score (DDS) was calculated based on Kant's method. Statistical analysis was performed using R software by the mixed effect model method. RESULTS: The mean DDS of the participants in 2017 (5.07 ± 1.20) was higher than that in 2021 (4.94 ± 1.09) (p < 0.05). DDS and dairy diversity score decreased significantly over time. After adjusting for confounders, there was an inverse relationship between the DDS and Body Mass Index (BMI) (B = -0.22; SE = 0.09), but the interaction effect of year × DDS (B = 0.19; SE = 0.10) was not significant (p = 0.06). However, there was a positive relationship between the DDS and A Body Shape Index (ABSI) (B = 0.00; p = 0.022), after adjusting for confounders, this relationship was no longer significant. Additionally, the interaction effect of year and DDS on the ABSI was not significant. CONCLUSION: The dietary intake and dietary diversity of older adult residents of Tehran declined dramatically with age, and a higher DDS was associated with improved anthropometric indices. DDS had an inverse relationship with general obesity in the studied participants, and the passage of time did not affect this relationship. The DDS can be used as a predictive index and is a powerful tool for investigating changes in nutritional status in longitudinal studies of old age. However, longer-duration studies are needed to obtain more conclusive results.

Diet and Nutritional Status of Women of Reproductive Age (15-49 Years) in Indigenous Communities of Attappady, Kerala, India.

The dietary patterns and quality of diets of women of reproductive age (WRA) significantly affect their health and that of their children. The suboptimal diet among women can lead to issues such as intrauterine growth retardation, low birth weight, premature birth, and malnutrition. To examine the dietary patterns and nutrient intake of WRA in the indigenous communities of the Attappady tribal block in Kerala, we conducted a cross-sectional study in 20 randomly selected villages in 2022. The study involved 24 h dietary recall surveys, anthropometric measurements, and estimation of hemoglobin concentration to assess nutrient intake and nutritional status. A total of 446 women aged 15-49 from 423 households participated, with 92 households included in the diet survey. The findings indicated that the diet was primarily based on cereals and root-based starchy staples, with low consumption of dairy products, fruits, and vegetables. The estimated intakes of major nutrients, except for protein, were lower than the recommended dietary allowance (RDA). Nearly 50% of the WRA were malnourished. About 32% of non-pregnant and non-lactating (NPNL) women and 40% of lactating mothers suffered from chronic energy deficiency (BMI < 18.5 kg/m2). Conversely, 13.4% of NPNL women and 15% of lactating mothers were overweight or obese (BMI ≥ 25 kg/m2). A total of 12.5% of adolescent girls aged 15-19 were thin (BAZ < -2 SD), and 10.5% were overweight or obese (BAZ > +1 SD). Since the co-existence of micronutrient deficiencies and undernutrition is rooted in the socio-cultural aspects of indigenous tribes, a culturally sensitive nutrition intervention model would be appropriate for the better health and wellbeing of women in the community.

Dietary diversity and iron deficiency anemia among a cohort of singleton pregnancies: a cross-sectional study.

BACKGROUND: Iron deficiency anemia (IDA) is considered one of the most common medical disorders observed during pregnancy. In low- and middle-income countries (LMICs), anemia and micronutrients deficiencies among pregnant women are associated with low consumption of animal products, monotonous starchy-diets, and seasonal consumption of vegetables and fruits. METHODS: A cross-sectional study was conducted with 198 pregnant mothers aged between 19-45 years who visited the antenatal care clinics in Northern Jordan to document the prevalence of IDA and to describe the associations between dietary diversity, diet quality scores and oral iron supplementation with the pregnant women iron status. Participants were stratified into three groups by gestational age (n = 66 women per group). Gestational age, blood parameters, minimum dietary diversity score (MDD-W), and prime diet quality score for healthy (PDQSHF) and unhealthy foods (PDQSUF) were assessed using 24- hour dietary recall. RESULTS: Prevalence of mild to moderate anemia was 27.8% among pregnant women. Third-trimester pregnant women were most affected. 52.5% have depleted iron stores (ferritin < 15 ng/ml), of them 30.8% have iron deficiency, and 21.7% have IDA. The (M ± SD) of the MDD-W, PDQSHF, and PDQSUF were 4.8 ± 1.6, 12.8 ± 3.9, and 7.2 ± 2.8 respectively. 52.5% achieved the MDD-W, 68% consumed < 4 servings/week of healthy food groups, and 50% consumed > 4 servings/week of unhealthy food groups. Mothers with higher MDD-W and PDQS had higher Hb and serum concentrations. Those taking iron supplements had significantly (p = 0.001) higher means of Hb, serum ferritin, and gestational weight gain. Significant differences were also found between PDQSHF, PDQSUF and the first and third trimester. CONCLUSIONS: Mild to moderate IDA is prevalent among pregnant mothers, especially in the third trimester. However, the prevalence of IDA among Jordanian pregnant women is lower than the global average. A high-quality, diverse diet, combined with oral iron supplementation and food fortification with iron, will help improve iron status, prevent anemia, and reduce its prevalence.

Dietary Diversity and Associated Factors among Children 6-23 Months Old in Ethiopia: Systematic Review and Meta-Analysis.

BACKGROUND: Feeding diversified food for children is the major indicator of nutritional quality and adequacy that is crucial during the complementary feeding period for infants and young children aged 6-23 months. Ensuring diversified food is highly essential for the normal growth and development of the infant and young children. In Ethiopia, malnutrition and food insecurity remain prevalent, underscoring the need to understand and improve dietary diversity among children. The primary objective of this review was to determine the pooled prevalence of dietary diversity and its associated factors among children aged 6-23 months in Ethiopia. METHODS: We thoroughly searched some electronic databases, including Pub Med, Africa Index Medicus, Science Direct, Hinari, and Google Scholar, to perform a meta-analysis. Excel was used to extract and combine the data, while Stata 17 was used for statistical analysis. To estimate pooled prevalence rates and related associated factors, we used a random-effect model and the Der Simonian-Laird technique. The I2-test was utilized to examine heterogeneity, and funnel plots, in conjunction with Egger's and Begg's tests, were employed to investigate publication bias. RESULT: This review analyzed 42 full-text studies, finding a pooled prevalence of 26.78% (95% confidence interval (CI): 23.35-30.21) with significant heterogeneity (I2 = 98.95%). Maternal education levels-college & above Adjusted Odds Ratio (AOR: 5.377, 95% CI: 3.116-9.279), secondary and above (AOR: 3.324, 95% CI: 1.939-5.700), primary (AOR: 3.065, 95% CI: 2.275-3.129), and formal education (AOR: 2.484, 95% CI: 1.722-3.583)-showed higher odds than counterparts. Similarly, fathers' education-secondary and above (AOR: 2.837, 95% CI: 1.981-4.065) and primary (AOR: 2.082, 95% CI: 1.016-4.266)-and father's occupation as merchant (AOR: 2.739, 95% CI: 1.355-5.539), and mother's occupation as housewife (AOR: 3.636, 95% CI: 2.457-5.381) showed higher odds. Additionally, male child sex (AOR: 1.877, 95% CI: 1.185-2.972), child age 18-23 months (AOR: 2.470, 95% CI: 1.568-3.987), and 12-17 months (AOR: 2.460, 95% CI: 1.914-3.163) indicated higher odds than counterparts. Having Postnatal Care (PNC) follow-up, counseling on infant and young child feeding (IYCF) practices, and no history of child illness were associated with higher odds (AOR: 3.155, 95% CI: 2.104-4.732), (AOR: 2.960, 95% CI: 2.288-3.829), and (AOR: 2.420, 95% CI: 1.765-3.318), respectively. Maternal knowledge of dietary diversity, urban residency, Antenatal Care (ANC) follow-up, child growth monitoring, and media exposure also showed higher odds. Similarly, maternal age groups 25-34 years and 35-44 years had higher odds compared to those aged 15-24 years. Other factors associated with higher odds included home grading, food security, institutional delivery, availability of cow milk, and household wealth index. CONCLUSION: Among Ethiopian children aged 6-23 months, the prevalence of recommended dietary diversity feeding practices was remarkably low, with only about 25% meeting the minimum recommended diversified food. The scientific predictors factor affecting dietary diversity included maternal media exposure, place of delivery, food security, urban residency, availability of cow milk, child growth monitoring, age, and knowledge of IYCF practices; paternal factors like education and occupation; child-related variables like age, sex, and history of illness; and history of ANC and PNC.

A diverse diet increases animal growth performance and carcass yield of grazing lambs.

The current experiments were conducted across two lamb finishing seasons (2019 [experiment 1; Exp1] and 2020 [experiment 2; Exp2]). In both experiments lambs were provided a monotonous (MON) diet (annual ryegrass [Lolium multiflorum L.] during 2019 and perennial ryegrass [L. perenne L.] and white clover [Trifolium repens L.] during 2020) or a diverse (DIV) diet composed of spatially separated strips sown to chicory (Chicorium intybus L.), plantain (Plantago lanceolata L.), perennial ryegrass, lucerne (Medicago sativa L.), and dock (Rumex obtusifolius). During Exp1, the DIV lambs had a stocking rate (SR) of either 80, 95, 100, or 110 m2/lamb/wk, whereas the MON lambs had a 100 m2/lamb/wk SR. In Exp2, the SR aimed to allocate the MON lambs with twice the forage allowance (kg DM/lamb/d) as DIV lambs. In Exp1, all lambs provided DIV had a greater (P < 0.01) average daily gain (ADG; + 130%) than MON rams, independent of the SR. Accordingly, DIV had greater (P < 0.05) hot carcass weight (HCW; + 26%) and aged carcass weight (CW; + 27%) compared with MON, across all SR. The 80 m2/lamb/wk SR tended to have a greater (P = 0.10) dressing percentage and had similar (P = 0.29) drip loss percentage to the MON lambs, while the other DIV lamb SR all had greater (P < 0.05; +12%) dressing percentages and lower (P < 0.05) drip loss percentage than MON lambs. In Exp2, DIV lambs had greater (P < 0.01) ADG (+37%), HCW (+15%), and dressing percentage (+6%) compared with MON lambs. This improved animal performance occurred despite being offered 57% less (P = 0.01) dry matter (DM), 56% less (P < 0.01) digestible DM, and 57% less (P = 0.02) metabolizable energy per lamb per day. Ultimately, these experiments demonstrate that providing growing lambs a functionally diverse diet improves animal growth performance and carcass weight compared with a monotonous diet of annual ryegrass or a mixed sward containing perennial ryegrass with white clover.

Dietary diversity and associated factors among households and children in internally displaced person camps in Southern Somalia: A cross-sectional study.

The study aimed to assess household and child dietary diversity in Southern Somalia by identifying determinants of adequate dietary diversity in three internally displaced person (IDP) camps in Baidoa, Dayniile and Dharkanley. A total of 1655 female main caregivers with 2370 children (6-59 months old) were included. Data on household dietary diversity score and child dietary diversity score indicators were collected from all households. The questionnaire was read face-to-face to the female main caregivers. Multivariate logistic regression analysis was performed to identify factors associated with adequate dietary diversity, which was defined as the consumption of at least four food groups within 24 h before the survey. The proportion of households achieving adequate HDDS was high in all locations 95.8%, 96.9% and 89.0% in Baidoa, Dharkanley and Dayniile, respectively, and the total adequate household dietary diversity score (AHDDS) was 95.6%. The proportion of adequate child dietary diversity score (ACDDS) was achieved in 63.5%, 8.5% and 38.3%. The main factors associated with AHDDS were larger household size, greater wealth, attendance of antenatal care (ANC) and joint decision-making between husband and wife, while factors associated with ACDDS included ANC attendance, age, the consumption of ready-to-use therapeutic food and deworming tablets. These findings can guide future programmes and policies aimed at improving maternal and child nutrition in IDP camps in Somalia. By tackling these diverse factors, a promising pathway emerges to enhance the nutritional welfare of both households and children in IDP camps.

Dietary Biodiversity and Diet Quality in Dutch Adults.

Dietary biodiversity, defined as the variety of consumed plants, animals and other organisms, can be measured by dietary species richness (DSR). This study investigated associations between DSR and diet quality in Dutch adults. Dietary intake data of 2078 Dutch participants, aged 19 to 79 years, were collected by the Dutch National Food Consumption Survey between 2012 and 2016 via two non-consecutive 24-h dietary recalls. DSR scores were calculated based on the total count of unique species consumed per individual over the two measurement days. An overall DSR score and separate scores for fruit and vegetable species consumption were calculated. The Dutch Healthy Diet index 2015 (DHD15-index) was used to measure diet quality. Linear regression analyses were performed to investigate associations between DSR scores and DHD15-index. Analyses were stratified by age and adjusted for relevant confounders. In total, 157 unique species were identified within the investigated food groups. On average, individuals consumed 13 unique species over two days (SD 4.55). For every additional species consumed, the DHD15-index increased by 1.40 points (95%CI 1.25-1.55). Associations between DSR and DHD15-index were higher in younger adults. DSR fruit showed the strongest associations with DHD15-index (ß 4.01 [95%CI 3.65-4.38]). Higher DSR scores are associated with higher diet quality in Dutch adults. These newly developed DSR scores create opportunities for further research to explore the implications of dietary biodiversity in Western diets on health and related outcomes.

Dietary Features Are Associated with Differences in the Urinary Microbiome in Clinically Healthy Adult Dogs.

Nutrition plays an important role in shaping the gut microbiome composition, although the impact of diet on the urinary microbiome (i.e., urobiome) remains unknown. The aim of this pilot study was to discover how nutritional features affect the diversity and composition of the urobiome in dogs. Dietary histories were obtained for 15 clinically healthy adult dogs, including limited nutrient (protein, fat, crude fiber), commercial diet brand, and dietary diversity profiles. The urine samples were collected via cystocentesis, followed by sequencing of the bacterial 16S rRNA gene. The data were analyzed to determine associations between major nutrients and dietary sources with the urobiome's composition. The protein, fat, and crude fiber contents had no statistically significant effect on the alpha or beta diversity. However, the beta diversity values differed (PERMANOVA; p = 0.017, R2 = 0.10) between dogs fed one commercial diet brand compared to dogs consuming any other brand. The beta diversity values also differed (p = 0.019, R2 = 0.10) between dogs consuming more diverse daily diets compared to those consuming less diverse diets (≥3 or <3 unique food sources, respectively). Overall, the results of this pilot study suggest that diet might impact the urobiome and support further exploration of the relationship between diet and the urobiome's composition in dogs.

Association of vision and hearing impairment and dietary diversity among the oldest old in China: findings from the Chinese longitudinal healthy longevity survey.

BACKGROUND: The presence of sensory impairment among older age cohorts exerts a significant impact on both individuals and society generally. Although the impact of dietary patterns on health is vital across all stages of life, there still a paucity of comprehensive research on the association between dietary variety and sensory impairments. OBJECTIVE: To investigate the potential relationship between dietary diversity and the prevalence of visual and hearing impairment or dual sensory impairments (visual and hearing impairment) among the oldest old population. METHODS: This is a cross-sectional study relied on data obtained from the 2018 survey conducted by the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Subjects aged 80 and older with complete vision and hearing data were included in the study. Multivariate logistic regression models were developed to examine the association between dietary components and visual and hearing impairment while controlling for age, gender, socioeconomic demographic factors, living habits, other food habits, and general health status. RESULTS: The study included 10,093 participants, with an average age of 92.29 ± 7.75 years. Vision and hearing function were assessed based on the ability to distinguish the direction of the break in the circle and the requirement for hearing aids, respectively. Upon controlling for confounding variables, individuals with a greater Dietary Diversity Score (DDS, the number of food groups, range: 1-11) had a reduced likelihood of experiencing visual impairment (odds ratio [OR] = 0.944, 95% confidence interval [CI], 0.915-0.974) and dual sensory impairment (OR = 0.930, 95% CI, 0.905-0.955). In comparison to the low dietary variety group (insufficient dietary diversity, DDS < 4), the high dietary diversity group (sufficient dietary diversity, DDS ≥ 4) exhibited a decreased risk of visual impairment (OR = 0.820, 95% CI, 0.713-0.944) and dual sensory impairment (OR = 0.751, 95% CI, 0.667-0.846). However, no statistically significant correlation was observed between dietary diversity and the presence of only hearing impairment (OR = 0.924, 95% CI, 0.815-1.047) (P < 0.05). CONCLUSIONS AND IMPLICATIONS: The synthesis of research findings suggests that following diverse dietary patterns and healthy nutritional practices may be an effective and affordable way to prevent age-related decline in visual impairment and dual sensory impairment.

Household food insecurity, dietary diversity with undernutrition among children younger than five years in Indian subcontinent-a narrative review.

The emerging predictors of childhood undernutrition include household food insecurity (HFI) and inadequate diet diversity (DD). Geographical, socio-cultural, economic, and demographic factors contribute to HFI. Earlier, HFI was often considered an outcome of hunger and poverty leading to undernutrition. The increasing availability of data related to childhood DD and its direct association with undernutrition indicates that DD could mediate the relationship between HFI and undernutrition. This narrative review examined the association of HFI and/or DD with undernutrition in children younger than 5 years in the Indian subcontinent; and the current programmes and policies. The current evidence showed a possible association between HFI and DD either independently or together with childhood undernutrition. Until now, nutrition-specific interventions to address moderate and severe forms of undernutrition were focused, with a limited attention on nutrition-sensitive approaches to improve HFI and DD. Interventions which improve HFI and DD may be included in the existing programmes and would help address the undernutrition in children younger than 5 years.

Dietary diversity among women with depressive and generalized anxiety symptoms in Nepal.

This study sought to determine whether there was any correlation between the dietary diversity score and symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in Nepali women who were of reproductive age. In a national cross-sectional population-based survey of women (15-49 years) (N = 7442) in Nepal, MDD was assessed with the PHQ-9 and GAD with the GAD-7, and dietary diversity with a 24 h food consumption recall of 10 food groups. Multinominal and logistic regression were used to estimate predictors of MDD and GAD symptoms. The prevalence of mild and moderate-to-severe MDD symptoms was 15.7% and 5.4%, respectively, and the prevalence of mild and moderate-to-severe GAD symptoms was 20.8% and 7.5%, respectively. The overall dietary diversity mean score was 4.66 (SD = 1.67). In the final multivariable model, adjusted for relevant confounders, dietary diversity was inversely associated with moderate-to-severe MDD symptoms (Adjusted Incidence Risk Ratios-AIRR: 0.90, 95% CI 0.84-0.97), and with moderate-to-severe GAD symptoms (AIRR: 0.86, 95% CI 0.80-0.92). Furthermore, in the fully adjusted regression model, pulses (Adjusted Odds Ratio-AOR: 0.77, 95% CI 0.60-0.98) and Vitamin A rich fruits and vegetables (AOR: 0.69, 95% CI 0.51-0.94) were inversely associated with MDD symptoms. In addition, Vitamin A rich fruits and vegetables (AOR: 0.57, 95% CI 0.43-0.75), dairy (AOR: 0.80, 95% CI 0.67-0.97), and pulses (AOR: 0.69, 95% CI 0.56-0.85) were inversely associated with GAD symptoms. Dietary diversity was inversely associated MDD and GAD symptoms.

Low Dietary Diversity and Low Haemoglobin Status in Ghanaian Female Boarding and Day Senior High School Students: A Cross-Sectional Study.

Background and Objectives: Anaemia is one of the most common forms of malnutrition globally, with most anaemia cases related to micronutrient deficiency. Diets with higher dietary diversity scores (DDS) are usually nutritionally diverse and could positively impact micronutrient status, including haemoglobin (Hb) concentration improvement. The study aimed to determine DDS and its association with the Hb concentration of Boarding and Day adolescent Senior High School students in Ghana. Materials and Methods: A semi-structured and three 24 h dietary recalls were used to obtain the participants' demographic and diet intake data, respectively. Hb concentration was assessed using a validated portable haemoglobinometer. DDS was evaluated using the Minimum Dietary Diversity for Women (MDD-W) approach. Results: A significant difference in the DDS between Boarding and Day students existed. Only 22% of the Boarding students had adequate dietary diversity, whereas 64% of the Day students had adequate dietary diversity. A significantly smaller proportion of the Boarding students consumed nuts and seeds, dairy, flesh foods, eggs, vitamin A-rich vegetables and fruits, other vegetables, and other fruits compared to Day students (p < 0.05, all). No significant difference (p = 0.925) in mean (±SD) Hb concentrations between Boarding (11.9 ± 1.1 g/dL) and Day (11.9 ± 1.1 g/dL) students was found. Additionally, no significant correlation between mean DDS and Hb concentration (p = 0.997) was recorded. Using Hb < 12 g/dL as the determination of anaemia, 55.1% Boarding and 57.8% Day students had anaemia. Conclusions: Low dietary diversity in Boarding students highlighted inadequate nutrition provided by school meals. Strategies to increase meal diversity should be prioritised by stakeholders in Ghana's educational sector.

Understanding modifiable caregiver factors contributing to child development among young children in rural Malawi.

This study examined modifiable caregiver factors influencing child development in Malawi using baseline data from 1,021 mothers and their children <2 years of age participating in a cluster-randomized controlled trial implemented in rural Malawi (2022-2025). We fit an evidence-based theoretical model using structural equation modelling examining four caregiver factors: (1) diet diversity (sum of food groups consumed in the past 24 h), (2) empowerment (assessed using the project-level Women's Empowerment in Agriculture Index), (3) mental health (assessed using the Self-Reported Questionnaire, SRQ-20), and (4) stimulation (number of stimulation activities the mother engaged in the past 3 days). Child development was assessed using the Malawi Development Assessment Tool (norm-referenced aggregate Z-score). The model controlled for child, caregiver, and household socioeconomic characteristics. Results showed that caregiver dietary diversity was directly associated with higher child development scores (standardized coefficient 0.091 [95% CI 0.027, 0.153]) and lower SRQ-20 scores -0.058 (-0.111, -0.006). Empowerment was directly associated with higher child development scores (0.071 [0.007, 0.133]), higher stimulation score (0.074 [0.013, 0.140]), higher dietary diversity (0.085 [0.016, 0.145]), and lower SRQ-20 scores (-0.068 [-0.137, -0.002]). Further, higher empowerment was indirectly associated with improved child development through enhancement of caregiver dietary diversity, with an indirect effect of 0.008 (0.002, 0.018). These findings highlight the important role that caregiver diet and empowerment play in directly influencing child development and other aspects of caregiver well-being. Interventions aimed at enhancing child development should consider these factors as potential targets to improve outcomes for children and caregivers.

How Do Social and Behavioral Change Interventions Respond to Social Norms to Improve Women's Diets in Low- and Middle-Income Countries? A Scoping Review.

Healthy dietary practices are highly influenced by social norms, the widely-held expectations about the behaviors that are appropriate or typical within a given group. However, many nutrition programs designed to reduce women's undernutrition in low- and middle-income countries do not address the influence of social and gender norms in their interventions, and therefore, there is limited information about how norms-responsive interventions have been designed and implemented. The objective of this scoping review was to identify and describe social and behavioral change interventions designed to improve women's dietary practices and nutritional intake that integrate the influence of social and gender norms. We systematically searched 4 databases (Scopus, Web of Science, PubMed, and CINAHL) for peer-reviewed articles describing design, implementation, and/or assessment of nutrition interventions in low- or middle-income countries. Results are reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our review identified 27 articles from 25 projects or research studies that addressed social or gender norms related to women's dietary practices. The majority focused on the pregnancy and lactation periods, and a few aimed to reach all women of reproductive age. Interventions most often endeavored to shift norms through multiple activities, channels, and platforms, aiming to reach not only the primary participants but also influencers and reference groups. Intervention approaches ranged from home visits and support groups to engage influential family members to community-level outreach with opinion leaders such as religious leaders, health care workers, and peer change agents. Most interventions were delivered through the health sector or were community-based, with some nutrition-sensitive agriculture interventions. There is increasing, although still limited, integration of social and gender norms perspectives in the design, implementation, and assessment of interventions to improve women's diets. This comprehensive review summarizes influential norms and intervention approaches, an important step toward enhancing the effectiveness of social and behavioral change interventions by addressing nutrition-relevant norms. This study was registered at Open Science Framework as JSBF7.

Association between social isolation and diversity in food intake by gender in community-dwelling older adults: A cross-sectional study.

AIM: Few studies have investigated the relationship between low dietary variety and clearly defined social isolation by gender. This study explored the association between dietary variety and social isolation, classified by operational definition, separately by gender in community-dwelling older adults. METHODS: This cross-sectional study recruited respondents via mail. A total of 4798 participants aged ≥65 years participated in the on-site assessment. Social isolation was assessed by "lack of conversation," "lack of passive support," "lack of offering support," and "lack of social participation." Dietary variety was evaluated using the Dietary Variety Score (DVS). RESULTS: The participants' median age was 73 (interquartile range 25-75: 69-77) years, and 2147 (44.7%) were male. After adjusting for covariates, with regard to male participants, a lack of offering support (ß = -0.051, P = 0.019) and a lack of social participation (ß = -0.089, P < 0.001) were associated with a low DVS. For female participants, only a lack of social participation was related to a low DVS (ß = -0.067, P < 0.001). A lack of conversation and passive support were not associated with a low DVS for both genders (P >0.05). CONCLUSION: The results indicate that encouraging social participation, regardless of gender, as well as preventing a lack of offering support for others among men, may contribute to improving individuals' DVS. Geriatr Gerontol Int 2024; ••: ••-••.

Micronutrient deficiency, dietary diversity, and sociodemographic and lifestyle determinants of dietary diversity among pregnant slum-dwelling women in Pune, India.

BACKGROUND: Increasing dietary diversity is a sustainable solution to combat micronutrient deficiencies. Given the large slum population in urban India, double burden of malnutrition, nutritional transition among slum-dwellers, and limited studies focusing on dietary intake and diversity among pregnant slum-dwellers, this study aimed to 1) describe macro- and micronutrient intakes and compare them with guidelines, 2) describe dietary diversity and intake of unhealthy foods and, 3) investigate the sociodemographic and lifestyle determinants of adequate dietary diversity among pregnant slum-dwellers in Pune, Maharashtra, India. METHODS: This study presents cross-sectional data of 454 pregnant slum-dwelling women completing mid-pregnancy visit collected from a larger cohort study. Sociodemographic and lifestyle data were collected at baseline (< 12 weeks gestation). Dietary data (24-h dietary recall) were collected in mid-pregnancy (23 ± 2 weeks). Nutrient intakes were compared with the Estimated Average Requirements (EAR) for pregnant Indian women. Dietary diversity score (DDS, range 0-10) and unhealthy food (sweet snacks, sweet beverages, fried and salty food) group score (range 0-3) were calculated as per FAO guidelines. Multivariate logistic regression was conducted to examine determinants of adequate dietary diversity (DDS ≥ 5). RESULTS: The average age of women was 25 (4.5) years. The median (Q1, Q3) total energy and protein intakes were 1771 (1456, 2185) kcal/d and 44.7 (34.7, 55.0) g/d, respectively. Total energy and protein were consumed as per EAR by 37% and 54% of women, respectively. Forty percent of women exceeded the recommended energy intake from carbohydrates. Diets of slum-dwelling women were lacking in multiple micronutrients (especially iron, zinc, riboflavin, thiamine, folate). The mean DDS was 4.2 ± 1.2 and 36.5% of the women had DDS ≥ 5. All women consumed mainly cereal-based starchy staples; 80% consumed pulses and legumes, and 60% consumed other vegetables. Fifty-nine percent of women consumed ≥ 2 unhealthy food groups. Higher educational and occupational status of the primary earning members of the family and lower parity were determinants of adequate dietary diversity. CONCLUSION: The diets of pregnant slum-dwelling women were lacking in numerous micronutrients. Dietary counselling programs need to be tailored to the socioeconomic backgrounds of pregnant slum-dwelling women and involve their family members to improve reach and effectiveness.