Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 95
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Aguayo, Víctor M. Nair, Rajilakshmi Badgaiyan, Nina and Krishna, Vandana 2016. Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra's comprehensive nutrition survey. Maternal & Child Nutrition, Vol. 12, p. 121.

    Dao, Maria Carlota Everard, Amandine Aron-Wisnewsky, Judith Sokolovska, Nataliya Prifti, Edi Verger, Eric O Kayser, Brandon D Levenez, Florence Chilloux, Julien Hoyles, Lesley Dumas, Marc-Emmanuel Rizkalla, Salwa W Doré, Joel Cani, Patrice D and Clément, Karine 2016. Akkermansia muciniphilaand improved metabolic health during a dietary intervention in obesity: relationship with gut microbiome richness and ecology. Gut, Vol. 65, Issue. 3, p. 426.

    Faber, Mieke Laubscher, Ria and Berti, Cristiana 2016. Poor dietary diversity and low nutrient density of the complementary diet for 6- to 24-month-old children in urban and rural KwaZulu-Natal, South Africa. Maternal & Child Nutrition, Vol. 12, Issue. 3, p. 528.

    Korkalo, Liisa Erkkola, Maijaliisa Heinonen, Arja E. Freese, Riitta Selvester, Kerry and Mutanen, Marja 2016. Associations of dietary diversity scores and micronutrient status in adolescent Mozambican girls. European Journal of Nutrition,

    Li, You Qin, Jian Wei, Xiao Li, Chunhong Wang, Jian Jiang, Meiyu Liang, Xue Xia, Tianlong and Zhang, Zhiyong 2016. The Risk Factors of Child Lead Poisoning in China: A Meta-Analysis. International Journal of Environmental Research and Public Health, Vol. 13, Issue. 3, p. 296.

    Maslin, Kate Dean, Tara Arshad, Syed Hasan and Venter, Carina 2016. Dietary variety and food group consumption in children consuming a cows' milk exclusion diet. Pediatric Allergy and Immunology, Vol. 27, Issue. 5, p. 471.

    Nair, Madhavan K. Augustine, Little Flower and Konapur, Archana 2016. Food-Based Interventions to Modify Diet Quality and Diversity to Address Multiple Micronutrient Deficiency. Frontiers in Public Health, Vol. 3,

    Nyaradi, Anett Li, Jianghong Foster, Jonathan K. Hickling, Siobhan Jacques, Angela O'Sullivan, Therese A. and Oddy, Wendy H. 2016. Good-quality diet in the early years may have a positive effect on academic achievement. Acta Paediatrica, Vol. 105, Issue. 5, p. e209.

    Tavakoli, Sogand Dorosty-motlagh, Ahmad Reza Hoshiar-Rad, Anahita Eshraghian, Mohamad Reza Sotoudeh, Gity Azadbakht, Leila Karimi, Mehrdad and Jalali-Farahani, Sara 2016. Is dietary diversity a proxy measurement of nutrient adequacy in Iranian elderly women?. Appetite, Vol. 105, p. 468.

    Useche, Pilar and Twyman, Jennifer 2016. Food Security in a Food Abundant World.

    Anderman, Tal Lee DeFries, Ruth S. Wood, Stephen A. Remans, Roseline Ahuja, Richie and Ulla, Shujayath E. 2015. Biogas Cook Stoves for Healthy and Sustainable Diets? A Case Study in Southern India. Frontiers in Nutrition, Vol. 2,

    Bernardo, Greyce Luci Proença, Rossana Pacheco da Costa Calvo, Maria Cristina Marino Fiates, Giovanna M.R. and Hartwell, Heather 2015. Assessment of the healthy dietary diversity of a main meal in a self-service restaurant. British Food Journal, Vol. 117, Issue. 1, p. 286.

    Castro-Quezada, Itandehui Román-Viñas, Blanca and Serra-Majem, Lluís 2015. The Mediterranean Diet.

    Issaka, Abukari I. Agho, Kingsley E. Page, Andrew N. L. Burns, Penelope Stevens, Garry J. and Dibley, Michael J. 2015. Determinants of suboptimal complementary feeding practices among children aged 6-23 months in seven francophone West African countries. Maternal & Child Nutrition, Vol. 11, p. 31.

    Jones, Andrew D. 2015. Household Food Insecurity is Associated with Heterogeneous Patterns of Diet Quality Across Urban and Rural Regions of Malawi. World Medical & Health Policy, Vol. 7, Issue. 3, p. 234.

    Jones, Andrew D. Fink Shapiro, Lilly and Wilson, Mark L. 2015. Assessing the Potential and Limitations of Leveraging Food Sovereignty to Improve Human Health. Frontiers in Public Health, Vol. 3,

    Leonardo, Wilson José Florin, Madeleine J. van de Ven, Gerrie W.J. Udo, Henk and Giller, Ken E. 2015. Which smallholder farmers benefit most from biomass production for food and biofuel? The case of Gondola district, central Mozambique. Biomass and Bioenergy, Vol. 83, p. 257.

    M’Kaibi, Florence K Steyn, Nelia P Ochola, Sophie and Du Plessis, Lisanne 2015. Effects of agricultural biodiversity and seasonal rain on dietary adequacy and household food security in rural areas of Kenya. BMC Public Health, Vol. 15, Issue. 1,

    Narmaki, Elham Siassi, Fereydoun Fariba Koohdani, Qorbani, Mostafa Shiraseb, Farideh Ataie-Jafari, Asal and Sotoudeh, Gity 2015. Dietary diversity as a proxy measure of blood antioxidant status in women. Nutrition, Vol. 31, Issue. 5, p. 722.

    Perez, E.M. Carrara, H. Bourne, L. Berg, A. Swanevelder, S. and Hendricks, M.K. 2015. Massage therapy improves the development of HIV-exposed infants living in a low socio-economic, peri-urban community of South Africa. Infant Behavior and Development, Vol. 38, p. 135.


Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

  • NP Steyn (a1), JH Nel (a2), G Nantel (a3), G Kennedy (a3) and D Labadarios (a4)
  • DOI:
  • Published online: 01 January 2007

To assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children.


Secondary data analyses were undertaken with nationally representative data of 1–8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated.


The children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7–8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the ‘other group’ (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity.


Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?
      Available formats
Corresponding author
*Corresponding author: Email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2TJ Ochoa , E Salazar-Lindo , TG Cleary . Management of children with infection-associated persistent diarrhea. Seminars in Pediatric Infectious Diseases 2004; 15: 229–36.

4A Hatloy , LE Torheim , A Oshaug . Food variety – a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. European Journal of Clinical Nutrition 1998; 52: 891–8.

5BM Ogle , PH Hung , HT Tuyet . Significance of wild vegetables in micronutrient intakes of women in Vietnam: an analysis of food variety. Asia Pacific Journal of Clinical Nutrition 2001; 10: 2130.

6A Onyango , KG Koski , KL Tucker . Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. International Journal of Epidemiology 1998; 27 484–9.

9MA Bernstein , KL Tucker , ND Ryan , EF O'Neill , KM Clements , ME Nelson , Higher dietary variety is associated with better nutritional status in frail elderly people. Journal of the American Dietetic Association 2002; 102: 1096–104.

12E Ferguson , R Gibson , C Opare-Obisaw , C Osei-Opare , C Lamba , S Ounpuu . Seasonal food consumption patterns and dietary diversity of rural preschool Ghanaian and Malawian children. Ecology of Food and Nutrition 1993; 29: 219–34.

15NP Steyn , D Labadarios , E Maunder , J Nel , C Lombard , U MacIntyre , Secondary anthropometric data analyses of the National Food Consumption Survey in South Africa: the double burden. Nutrition 2005; 21: 413.

17D Rose , S Meershoek , M McEwan . Evaluation of a rapid field tool for assessing household diet quality in Mozambique. Food and Nutrition Bulletin 2002; 23: 181–9.

20NI Hahn . Variety is still the spice of life. Journal of the American Dietetic Association 1995; 95: 1096–7.

24ET Kennedy , J Ohls , S Carlson , K Fleming . The healthy eating index: design and applications. Journal of the American Dietetic Association 1995; 95: 1103–8.

25AK Kant . Indexes of overall diet quality: a review. Journal of the American Dietetic Association 1996; 96: 785–91.

26A Drewnowski , SA Henderson , AB Shore , C Fischler , P Preziosi , S Hercberg . Diet quality and dietary diversity in France: implications for the French paradox. Journal of the American Dietetic Association 1996; 96: 663–9.

27D Feskanich , HRH Rockett , GA Colditz . Modifying the healthy eating index to assess diet quality in children and adolescents. Journal of the American Dietetic Association 2004; 104: 1375–83.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *