Dietary Diversity In Relation To Nutrient Adequacy and Nutritional Status Of Primary School Children In Rural Vietnam

School children especially in developing countries are affected by malnutrition, micronutrients deficiencies and nutrition related chronic diseases. Dietary diversity is a potential answer for solving the nutritional problems among school children. Dietary diversity, a cornerstone to a healthy diet is characterised by consuming a variety of foods within and across food groups. Increased dietary diversity has been reported in several studies to relate with adequate intake of energy and essential nutrients, thus leading to improved overall nutritional quality of diets and good health. Aim of this study was to explore relationships between dietary diversity and both nutrient adequacy and nutritional status of school children using data of a larger PhD-study among schoolchildren in rural Vietnam.

  Subjects in this study were 60 primary school children 5 –9 years from two primary schools in Tam Nong district. Nutritional status indicators used in this study are weight-for-height (WHZ), weight-for-age (WAZ) and height-for-age (HAZ) z-scores as well as iron status expressed as haemoglobin concentration. Dietary data was collected using 24-hour recall method, reporting all foods and drinks consumed within 24 hours before the interview day for each child. Dietary diversity was measured using food variety scores (FVS), and dietary diversity (DDS) representing the number of foods and food groups eaten by subjects daily as an average of two reference days, respectively. Nutrient adequacy was assessed using nutrient adequacy ratio (NAR), the ratio of nutrient intake (for energy, protein, fat & iron) to its RDA, and mean nutrient adequacy ratio (MAR) being the average of all NARs.

Results indicated that dietary diversity and food variety scores were low. The children consumed 5 food groups and 12 foods respectively and overall nutrient adequacy (MAR) was on average 0.60. Results show that dietary diversity score (DDS) and food variety score (FVS) are significantly, positively correlated to nutrient adequacy ratios (NAR) for all nutrients studied (energy, protein, fat and iron) and mean nutrient adequacy ratio (MAR). There is also a significant positive association between HAZ and DDS. FVS was negatively and significantly associated with WHZ. There were not significant correlations with wasting and haemoglobin concentrations and both DDS and FVS.

Malnutrition rates were high (stunting 29.4% and wasting 15.7%) in this group, reflecting inadequate nutrient intakes and low dietary diversity. Their diets are also based on plant foods, with low nutrient bioavailability. Associations between DDS/FVS and nutrient adequacy found in this study were comparable to those found in other past studies, despite different definitions and methodologies used. Stunting and underweight were associated with DDS and FVS respectively while no correlations were found with wasting and haemoglobin concentration. The absence of correlation with other nutritional status indicators could be due to other factors that maybe more important, such as socio-economic status and others. However these were not examined in this study. Conflicting results (no association) were also found in relationships with nutritional status indicators in other studies.

It is recommended that dietary diversity and food variety needs to be increased in this group to improve nutrient adequacy. Dietary diversity seems to have a potential as a cheap and simple method for dietary assessment and nutrition monitoring.