Minimum Dietary Diversity And Its Determinants Among Children Aged 6–60 Months Using The 24-Hour Dietary Recall Method - A Cross-Sectional Observational Study

Abstract

Background: Optimal dietary diversity during early childhood is critical for adequate micronutrient intake, linear growth, and cognitive development. Despite being a simple, non-invasive proxy for nutritional adequacy, dietary diversity remains suboptimal among under-five children in India. This study was planned to estimate the Minimum Dietary Diversity (MDD) and its determinants among children aged 6–60 months attending a tertiary-care teaching hospital and its field practice area.

Methods: A cross-sectional, community- and facility-based observational study was conducted over a period of 12 months in the Pediatric Outpatient Department and community field practice area of Chettinad Hospital and Research Institute (CHRI). A sample of 95 children aged 6–60 months was calculated .Dietary intake was assessed using the WHO-recommended 24-hour dietary recall with a repeat recall at two weeks. Anthropometry was measured and Z-scores were computed as per the WHO Child Growth Standards (2006).

Results: Of the 95 children studied, 53 (55.79%) achieved MDD (≥ 5 of 8 WHO food groups). Minimum Acceptable Diet (MAD) was achieved by 29 (30.53%). The commonly consumed food groups were grains/roots/tubers (96.8%) and dairy (87.4%); flesh foods (35.8%) and breast milk (27.4%, limited to younger children) were the least consumed. Children aged 24–60 months (adjusted OR [aOR] 22.62; 95% CI 5.63–90.91; p < 0.001) and those born to mothers > 30 years (aOR 6.69; 95% CI 1.94–23.00; p = 0.003) were significantly more likely to achieve MDD. Underweight and severely underweight children (aOR 0.08; 95% CI 0.02–0.32; p < 0.001) were significantly less likely to achieve MDD. Sex, birth order, and socioeconomic status showed no statistically significant association with MDD.

Conclusion: Slightly more than half of the children aged 6–60 months in the study setting achieved minimum dietary diversity. Younger age (6–23 months), younger maternal age, and underweight status emerged as key determinants of inadequate dietary diversity. Targeted complementary-feeding counselling for mothers of infants and young children, and focused nutrition-rehabilitation of underweight children, are required to bridge the diversity gap.