Beyond Diversity: How Dietary Pattern Analysis Adds to Our Understanding of Diet Quality in Rural Nepal.
O'Hara, Corey.
2019
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Background: Dietary
diversity scores are well-understood, validated indicators of diet quality in terms of
micronutrient adequacy for individuals and of food security in terms of caloric access
for households in low-income environments. The relationship between dietary diversity
and quality/sufficiency is not as clear at the upper end of the spectrum, however, where
components of higher-diversity ... read morediets may also be risk factors for negative health
outcomes. In wealthier environments, by contrast, dietary pattern analysis is commonly
used to identify combinations of foods consumed that have a relationship to human health
outcomes. Methods: This study identifies dietary patterns in individual food consumption
data from a clustered, controlled intervention trial in western Nepal and compares them
with dietary diversity scores across a range of analyses. First, we identify factors
associated with household and individual patterns. We assess the relationships of the
patterns to diversity scores constructed from the same 24-hour recall dietary diversity
survey data, and we describe differences in consumption between individuals consuming
each pattern and those achieving minimum dietary diversity according to conventional
indicators. Second, we look at associations between child dietary patterns and child
anthropometry to determine whether pattern scores are more or less predictive of
nutritional status than dietary diversity indicators. Third, we determine whether
agricultural production, diversification, and marketing intervention, compared to
marketing intervention alone, affects household dietary patterns over time. We assess
the effect of intervention on dietary patterns as distinct from dietary diversity, and
whether such pattern scores contribute additional information. Results: We find that
dietary patterns convey useful information about dietary quality that is additional to
what we learn from individual dietary diversity scores alone. We observe that indicators
derived from dietary patterns identify a smaller group of individuals than minimum
diversity scores and observe significant differences in diet between those consuming or
not consuming each pattern who meet the minimum diversity threshold. We find that in
this context, dietary patterns—but not dietary diversity—are associated
with child weight-for-height, with a dairy/sweets pattern predicting lower rates of
wasting and higher rates of overweight in children aged 6 to 59 months. Finally, we see
that over time, agricultural intervention is positively associated with adoption of a
varied dietary pattern, rather than the dairy/sweets pattern that is associated with
negative outcomes. Conclusions: In this population, dietary pattern analysis contributes
additional value to assessment of diet quality compared to use of dietary diversity
indicators alone. Pattern analysis identifies commonly consumed combinations of foods,
which can be useful in developing nutrition counseling interventions. Indicators
developed from dietary patterns can identify individuals who are not consuming critical
nutrient-dense foods despite meeting minimum diversity. Dietary patterns are associated
with child anthropometry, which can help to identify vulnerable populations while
informing future nutrition counseling interventions. Longitudinal analysis reveals that
dietary diversity scores on their own may mask effects that can be revealed by analysis
of dietary patterns.
Thesis (Ph.D.)--Tufts University, 2019.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Beatrice Rogers.
Committee: Beatrice Rogers, Patrick Webb, and John Hoddinott.
Keywords: Nutrition, and Economics.read less - ID:
- cn69mh77c
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