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Food groups to assess diet diversity

This question was posted the Infant and young child feeding interventions forum area and has 13 replies.

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Nicki Connell

Emergency Nutrition Advisor, Save the Children

Normal user

4 Jun 2013, 16:32

Hi all I see a similar question has been posted previously and been left unanswered, so I am going to re-post in the hopes there is someone who can advise on the best course of action! I have come across 2 classifications of food groups while researching how to measure dietary diversity: 1) 12 Food Groups (FANTA) — Cereals — Roots and tubers — Vegetables — Fruits — Meat, poultry, offal — Eggs — Fish and seafood — Pulses/legumes/nuts — Milk and milk products — Oils/fats — Sugar/ honey — Miscellaneous 2) 7 Food Groups (WHO) — grains, roots and tubers — legumes and nuts — dairy products (milk, yogurt, cheese) — flesh foods (meat, fish, poultry and liver/organ meats) — eggs — vitamin-A rich fruits and vegetables — other fruits and vegetables Firstly in the 7 food groups where would oil and sugar be classified? Secondly which classification is most relevant to use in assessing individual dietary diversity and household dietary diversity? Many thanks in advance.

Anonymous 2206

Independent consultant

Normal user

4 Jun 2013, 16:46

Hello, you should refer to the following, latest guidelines from FAO on assessing dietary diversity. It is based on 12 food groups and I find these guidelines clear and user-friendly. http://www.fao.org/fileadmin/user_upload/wa_workshop/docs/FAO-guidelines-dietary-diversity2011.pdf Good luck!

Anonymous 1278

Normal user

4 Jun 2013, 17:22

Hi there, Household Dietary Diversity Score (HDDS) consists of 12 food groups - refer to the FAO guideline suggested by Anonymous 220 Individual Dietary Diversity Score (IDDS) commonly also known as Women's Dietary Diversity Score (WDDS covers women in reproductive age, PLW - most vulnerable) consists of 9 food groups - refer to the FAO guideline suggested by Anonymous 220 7 food groups are recommended for children 6 months to 2 years of age - Core indicator for complementary feeding - refer to the guideline on 8 core indicators for IYCF endorsed by WHO/UNICEF/other agencies - Oil and sugar cannot be considered as food groups in this case! Good Luck!!

Noreen M Mucha

Independent Consultant

Normal user

4 Jun 2013, 19:17

FYI...... The Individual Dietary Diversity Score (IDDS) is NOT the same thing as the Womens Dietary Diversity Score (WDDS) as the IDDS can also be used for children. Individual Dietary Diversity Scores (IDDS) aim to reflect nutrient adequacy. Studies in different age groups have shown that an increase in individual dietary diversity score is related to increased nutrient adequacy of the diet. Individual Dietary Diversity Score (IDDS) is often used as a proxy measure of the nutritional quality of an individualís diet. The Individual Dietary Diversity Score (IDDS) reflects the nutrient adequacy of the diet and the food groups considered in this score place. IDD scores target more specifically young children and women of childbearing age, because of the importance of micronutrient adequacy for growth, development and protection of the fetus and infant. IDDS (women and young children) are now part of the Demographic and Health Survey (DHS) questionnaires (starting from 2005 / DHS-IV). Corresponding DHS reports are available from ORC Macro website (http://www.measuredhs.com/pubs/browse_type.cfm ).

Anonymous 525

Health and nutrition specialist

Normal user

4 Jun 2013, 19:39

Such a pity that this nice forum is regularly the theatre of aggressive answers... We are all there to learn something and I think mistakes can be corrected more gently, this would certainly be more effective.

Noreen M Mucha

Independent Consultant

Normal user

4 Jun 2013, 22:23

See Food and Nutrition Security Indicators: A Review. University of Bonn. Evita Hanie Pangaribowo, Nicolas Gerber, Maximo Torero, Working Paper 108. Department of Political and Cultural Change. Center for Development Research, University of Bonn Editors: Joachim von Braun, Manfred Denich, Solvay Gerke, Anna-Katharina Hornidge and Conrad Schetter, February 2013. Available at: http://www3.lei.wur.nl/FoodSecurePublications/05_Pangaribowo%20Gerber%20Torero_FNS%20Indicators.pdf

Tamsin Walters

en-net moderator

Forum moderator

5 Jun 2013, 09:23

Dear all, The comment from Anonymous 525 is a gentle reminder to us all to remain courteous and sensitive to others on this forum. It is often difficult to anticipate how written responses may come across to others and some messages may unintentionally appear more aggressive than intended. One suggestion we would like to propose is that people making strong, authoritative statements should preferably identify themselves so that others have some idea of who is making the statement and their evidence-base for the statements. It is not essential to identify yourself but would be helpful for others when understanding where/who the advice is coming from. Many thanks, Tamsin

Mark Myatt

Consultant Epidemiologist

Frequent user

5 Jun 2013, 17:03

You many get some more information if you post you question to the assessment forum. Briefly ... The 12 groups are for the Household Dietary Diversity Score (HDDS). There is a 9 group variant used for individuals (IDDS) or women (WDDS). These are described in FANTA documents. The 7 group score is what you want for IYCF. This is used in the (rather cumbersome) WHO indicator set, the ICFI score, and the small sample IYCF indicator set being developed by UNICEF, VALID, and some INGOs for use in RAM and S3M surveys. In this score, sugar is ignored but oil may be included in the vitamin A rich foods groups of this is fortified or naturally rich in vitamin A (e.g. red palm oil). It is also quite common to include green leafy vegetables in this group. I hope this is of some use.

Jane

Student

Normal user

21 Aug 2020, 23:54

Hi all! Please can someone reduce the 12 food groups for HDDS to 8 or 9 food groups? such as removing sweets, spices, condiments and sweets and putting all the vegetables together, fruits together especially when you don't have any interest in assessing their vitamin A status. 

How can I categorize HDDS into low, moderate and high dietary diversity. THANK YOU. 

Mark Myatt

Consultant Epidemiologist

Frequent user

24 Aug 2020, 10:00

A lot of work has gone into the design of these sorts of indicator.

You could omit sweets, spices, condiments, and beverages as these often do not contribute to to diet adequacy / quality. You should be aware that this may compromise the ability of the DDS to reflect food security ... the idea here is that food secure households tend to divert resources to tastier foods and food "treats". I'd be wary of lumping all the fruits and vegetables together as this might compromise the ability of DDS to reflect dietary adequacy / total diet quality. You should be OK if your grouping follows the aggregations used to calculate DDS which tends to group (e.g.) vitamin A rich foods together. See this EU/FAO guideline for groupings.

Another, probably better, approach would be to revive older DDS forms or use alternative DDS forms. You could (e.g.) apply the WDDS (9 group) to HDDS assessment.

You could use the WFP's "food consumption score" (FCS) which uses 8 food groups, consumption frequency, and a weighted score.

I note this was posted to the IYCF interventions forum. DDS for IYCF applications often uses just seven food groups.

I recall thar older DDS methods used nine or seven food groups. Validation work demonstrated that scores with more food groups tend to work better than those with fewer items and this has, I think, driven the design and adoption of indictors based on large numbers of food-groups.

You might find this FIC review useful.

When it comes to categorising scores ... you could (should) use the tresholds given in indicator guidelines - this is simplest. I have also used summary measures (e.g. the sample median or lower tercile to define low DDS). If you have some measure of wealth / poverty you could use the sample median DDS for households in poverty or in the lower tercile of the wealth score to define low DDS.
 

Jane

Student

Normal user

24 Aug 2020, 12:11

Hello Mark! I am so grateful for that reply. 

Rita Bhatia

Public health nutrition

Frequent user

24 Aug 2020, 14:44

  Hello Jane

 visit

wfp.infovam@wfp.org 

Noreen M Mucha

Independent Consultant

Normal user

25 Aug 2020, 05:41

I would not reccomend removing any food groups, ---however depending on the country you may need to emphasize or add food groups. You need to capture everything that is being consumed in the last 24 hours and taking out food groups may confuse emumerators. I conducted this in Laos and the following were the food groups:

1- Foods Made From Grains, White Roots and Tubers and Plantains (White Flesh)

The Food Groups

The following are illustrations of examples of each food group.

1- Foods Made From Grains, White Roots and Tubers and Plantains (White Flesh)

Bread, rice, corn, wheat, noodles, or other foods made from grains, including thick grain-based porridge.

Sweet biscuits and cakes are not included and are classified with number 16-“Sweets”.

White Roots, Tubers and Plantains (white flesh): white potatoes, yams, and cassava root.

  • Include non-colored items mainly providing carbohydrate.
  • This group includes all non-grain-based starchy staples.
  • Any staple dishes/casseroles and pastes made from roots, tubers and plantains should also be included in this category.

Figure 12: Grains, White Roots, Tubers and Plantains (white flesh)

 

2- Legumes/Pulses (Beans, Peas and Lentils)

Legumes/Pulses (beans, peas and lentils): Mature beans or peas (fresh or dried seed), lentils or soy products, including tofu and tempeh.

  • This group includes beans, peas and lentils.
  • This group does not include long green beans-it is in category 9 –vegetables.
  • It also does not include groundnut (peanut)-Groundnut is included in the “Nuts and seeds” group (group “3”).
  • This includes beans, sprouted pulses and processed/prepared products, such as hummus, tofu, tempeh, soy milk, soy cheese, texturized vegetable protein and other soy products and products.

Figure 13: Legumes/Pulses (Beans, Peas and Lentils)

 

3-Nuts and Seeds

Nuts and seeds: Any tree nut, groundnut/peanut or certain seeds, or nut/seed, butters, or pastes including sesame.

  • This group comprises mostly tree nuts but also includes groundnut (peanut) and may include certain seeds when a handful of them are eaten.
  • This group also includes nut and seed “butters”, such as pounded groundnut/peanut butter.
  • Note that oils extracted from nuts and seeds are not included in this group; they are included in group 13 “Other oils and fats”.

Figure 14: Nuts and Seeds

 

4- Dairy: Milk (NOT SOY) and Milk Products

Milk (NOT SOY) and milk products: Milk, cheese, yoghurt or other milk products but NOT including butter, ice cream, cream or sour cream.

  • This group includes almost all liquid and solid dairy products from cows, goats, buffalo, sheep or camels.
  • If there is uncertainty about quantities usually consumed, milk/dairy ingredients should not be classified in the “Milk and milk products” group to avoid inflating the proportion of women reported to consume the nutrient-dense dairy group.
  • Items included in this category:
    • Fresh whole, low-fat and skim milk when drunk/consumed as such
    • Reconstituted powdered or evaporated milk or ultra-high temperature (UHT) (boxed) milk consumed as such
    • Hard cheese (e.g. cheddar, mozzarella, Swiss, parmesan)
    • Soft cheese (e.g. ricotta, cottage, paneer)
    • Kefir
    • Yoghurt/curd

Items not included in this group and classified into other categories:

  • Butter, cream and sour cream: Classify with “Other oils and fats” (13) because of their high fat content and most typical culinary uses.
  • Cocoa drinks with milk: Classify with other beverages and food (14).
  • Ice cream: Classify with “Sweets” (16).
  • Processed/packaged yoghurt drinks: Classify with with other beverages and food (14) because these are usually high in sugar and low in dairy content.
  • Sweetened condensed milk: Classify with “Sweets”(16).
  • Tea or coffee with milk: Classify with “Other beverages and foods (14)” if unsweetened and with “Sugar-sweetened beverages” if taken with sugar.

Figure 15: Dairy

 

5- Meat, Poultry and Fish/Seafood

This group is sometimes referred to as “flesh foods”. All meats, organ meats, poultry and other birds and fresh and dried fish and seafood/shellfish are included. Wild birds and mammals (“bush meat”), snakes, frogs and other reptiles and amphibians are also included.

On the questionnaire, these appear as three subgroups:

  • Organ meat
  • Meat and poultry
  • Fish/seafood.

Organ Meat: Liver, kidney, heart, or other organ meats (including blood-based food).

  1. This group includes different types of red organ meats that are usually rich in iron. Because of their high iron content, blood sausage and other blood products are also included.
      • Blood sausage, other blood products
      • Gizzard
      • Heart
      • Kidney
      • Liver
      • Pale organ meats, such as tripe, are not included because the iron content is far lower. Tripe and other pale organ meat can be classified with “Meat and poultry”.

Meat and poultry: Beef, pork, lamb, goat, rabbit, wild game meat, chicken, duck or other bird, liver, kidney, heart, etc., including blood-based food.

  • All flesh meats from mammals, birds, reptiles and amphibians are included.
  • Processed meats are also included.
  • Beef, goat, lamb, mutton, pork, rabbit, yak, deer, antelope, buffalo or other large wild (bush meat) or domesticated mammals.

Fish/Seafood: Fresh or dried fish, eels shellfish, or seafood

  • This group includes fish and seafood from both marine and freshwater environments.
  • Fresh, frozen or dried fish, large or small, all species
  • Canned fish (e.g. anchovies, tuna and sardines)
  • Clams, mussels, oysters and scallops (bivalves)
  • Shrimp, lobster, crayfish and crabs (crustaceans)
  • Edible sea urchins and sea cucumbers (echinoderms)
  • Octopus, squid and cuttlefish
  • Shark
  • Whale
  • Fish roe and snails are not included and are classified with “Insects and other small protein foods (11)”.

Figure 16: Flesh Foods

 
 
 

6-Eggs

Eggs: duck, chicken, quail, other birds, snake, monitor lizard, etc.

This group includes all kinds of bird eggs.

  • Chicken eggs
  • Duck eggs
  • Guinea fowl eggs
  • Quail eggs

Figure 17: Eggs

 

7- Dark Green Leafy Vegetables

Dark Green Leafy Vegetables: are cassava leaves, kale, phak khad, phak hom, phak ihom, bay man dang, bay man ton, phak kut, phak gnok, bay mak hai, phak samek, phak van, etc. (exclude herbs eaten in small amounts).

  • Essentially all medium-to-dark green leafy vegetables are vitamin A-rich.
  • Only very light leaves, such as iceberg lettuce, are not.
  • In the absence of information on nutrient content, wild/foraged leaves that are medium-to-dark green can be assumed to be vitamin A-rich and placed in this group.

Figure 18: Vitamin A Dark Green Leafy Vegetables

 

8-Other Vitamin A rich Vegetables and Fruits

Pumpkin, carrots, squash, or sweet potatoes that are yellow, or orange inside.

  • Include only roots, tubers and other red/yellow/orange vegetables that are sources of vitamin A.

Vitamin A-rich fruits: Ripe mangoes, ripe papayas, fig, longan, litchee, pineapple, tamarind, mangosteen, etc (local vitamin-A rich fruits).

  • Note: Certain fruits (e.g. mango and papaya) are high in vitamin A when ripe, but not when eaten “green” or unripe. When they are eaten “green” (unripe), mango and papaya should be classified with “Other fruits”.
  • Only ripe mangos count if they are green they go in 10-other fruits.

Figure 19: Other Vitamin A Rich Vegetables and Fruits

 
 

9-Other Vegetables

Other vegetables: tomato, onion, eggplant, mushrooms, bamboo, mak buap, mak baep, long beans, etc.

  • This group includes legumes when the fresh/green pod is consumed (as in fresh peas, snow peas, snap peas or green beans).
  • This group does not include high-carbohydrate “starchy” roots and tubers, such as white potatoes, white yams, cassava, which are classified in the “White roots and tubers and plantains (1) group.
  • If the vegetable is pickled it DOES NOT go here and goes in the Other beverages and foods (14) group.

Figure 20: Other Vegetables

 

10-Other Fruits

This group includes most fruits, excluding vitamin A-rich fruits.

Other fruits: banana, guava, fig, longan, litchee, pineapple, tamarind, mangosteen, etc.

  • This group includes most fruits, excluding vitamin A-rich fruits and starchy fruits, such as plantain.
  • This group includes fresh and dried fruits but does not include sugar-sweetened processed fruit products; these should be classified with “Sweets”(16).

Figure 21: Other Fruits

 

11. Insects and Other Small Proteins

This category includes insects, insect larvae/grubs, insect eggs, fish roe, spiders, land and sea snails and any other small invertebrates. It does not include frogs, snakes or other reptiles and amphibians, which are included in the “Meat, poultry and fish” group. For Laos this includes (Figure 31) Grasshoppers, termites, bamboo caterpillar, wasps, dragonflies, mole cricket, short-tailed cricket, sting bug, cockchafer beetles, horned beetle, cicadas, giant water bugs.

Figure 22: Insects and Other Small Proteins

 
 

12- Condiments and Seasonings (including condiment vegetables)

  • This category includes all minor ingredients in mixed dishes, which primarily provide flavor and would be consumed in very small amounts in any individual serving of the dish.
  • It includes items added at any stage of cooking or when serving food (e.g. garnishes sprinkled on top of a dish to add flavour or visual appeal).
  • This category includes fresh or dried herbs, spices, chili peppers, ginger root, garlic, fish powder, bean paste, fermented bean paste, tomato paste and seeds added for flavour or to garnish mixed dishes.
  • It also includes bouillon cubes, “Maggi cubes” and similar items, soy sauce, fish sauce and pepper sauce. It includes sugar when sugar is added as a flavouring to mixed dishes or side dishes.

Figure 23: Condiments and Seasonings

 
 

13. Other Oils and Fats

Figure 24: Other Oils and Fats

 

This category includes all other solid and liquid oils and fats, including those of plant or animal origin. Examples are lard, suet (tallow) and butter (solid animal fats); margarine and “shortening” (hydrogenated vegetable oil); and a range of oils extracted from nuts, seeds and grains.

14- Other Beverages and Food

Figure 25: Other Beverages and Food

 

15. Savory and Fried Snacks

This category includes highly processed commercial products but also a variety of processed “street foods”.

Examples include:

  • Cassava chips, fried cassava balls, other cassava-based fried snacks
  • Corn/maize chips/fried tortilla strips
  • Crisps
  • Potato chips
  • Sweet potato chips
  • Puffs (cheese puffs, corn/maize puffs, other “puffs”)
  • Doughnuts/fried dough/“fry bread”
  • Samosas
  • Other deep-fried, mainly carbohydrate, snack foods

Note: Some of these items (e.g. samosas) may include small amounts of meat or vegetables but are high in fat and simple carbohydrate and often may be high in sodium as well.

Figure 26: Savory and Fried Snacks

 

16. Sweets

Figure 27: Sweets

 

This category includes highly processed commercial products but also a variety of locally produced and processed snacks and “street foods”.

Include all food items with a high content of different sweetening agents (e.g. sugar, corn syrup, other syrup, honey, molasses or jaggery), such as:

  • Biscuits (sweet)
  • Cakes
  • Candies (hard candies, toffees, “milk toffees” or candies made with sweetened condensed milk, any other candies)
  • Chocolates
  • Coconut candies and sweet biscuits, and other sweetened coconut snacks
  • Cookies
  • Fruit canned in sugar syrup
  • Fruit “gummy” candies, fruit “leathers”
  • Ice cream
  • Honey
  • Pastries (sweet, fried or baked)
  • Sesame seed candies
  • Sweetened condensed milk

Yibo Wood

Normal user

25 Aug 2020, 15:07

A recent Lancet paper showed that none of the MCH dietary metrics – DDS, FVS, HDDS, or WDDS has shown strong evidence of protecting MCH outcomes (wasting or stunting, etc). Here is the link to the paper - https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30162-5/fulltext

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