HYDERABAD: A simple food diversity checklist developed by researchers at the ICMR-National Institute of Nutrition (NIN) has emerged as a promising, low-cost tool for identifying school-age children at risk of micronutrient deficiencies, potentially strengthening nutrition programmes across India.
The study, published in the European Journal of Clinical Nutrition, found that a 13-food-group Diet Diversity Score (DDS) can accurately predict whether children are receiving adequate amounts of essential vitamins and minerals. Traditional methods of assessing micronutrient adequacy require detailed dietary recalls, food frequency questionnaires, trained personnel, significant time and financial resources.
To overcome these challenges, researchers developed a simplified DDS based on foods commonly eaten by rural Indian children. Instead of calculating exact nutrient intake, the tool counts the number of different food groups consumed during the previous 24 hours.
Foods were classified into 13 groups — cereals and millets, pulses, green leafy vegetables, other vegetables, roots and tubers, fruits, vitamin A-rich vegetables, vitamin A-rich fruits, milk and milk products, nuts and oilseeds, fats and oils, eggs and flesh foods. Each group consumed in quantities of at least five grams earned one point, producing a maximum score of 13.
Dr Subba Rao of ICMR-NIN said: “We wanted to determine whether a lower five-gram threshold, compared with the globally accepted 10 grams, could still predict micronutrient adequacy. And we found that children consuming foods from at least 10 of the 13 food groups achieved good micronutrient adequacy, even when each group contributed only five grams.”
Recommended food groups
The study involved 76 children aged six to 10 years from two villages in Telangana’s Ghatkesar sub-district. Researchers assessed intake of 10 key micronutrients — vitamins A, C, B12, thiamine, riboflavin, niacin, folate, iron, zinc and calcium — and validated the findings using blood tests for haemoglobin, ferritin, vitamins A, B12, D and folate. Although most children belonged to economically stable households, their diets relied heavily on cereals, while consumption of pulses, eggs, meat, nuts, fruits and green leafy vegetables remained limited.
The average Diet Diversity Score was 8.67, indicating that children consumed fewer than nine recommended food groups daily. The Mean Probability of Adequacy across 10 micronutrients was only 28%, with poor adequacy for riboflavin, vitamin B12, calcium, vitamin A, thiamine and iron. The study also found that 63.1% of children were anaemic, 51.3% had iron deficiency, 31.5% suffered from iron deficiency anaemia, 53.9% were deficient in vitamin D and 32.8% had vitamin B12 deficiency. Despite belonging to non-vegetarian households, many children consumed few eggs and flesh foods, contributing to these deficiencies.
The study found that children who consumed foods from at least 10 of the 13 food groups achieved around 70% micronutrient adequacy, making this the optimal threshold for predicting sufficient intake of essential vitamins and minerals. The five-gram DDS showed a strong positive correlation with overall micronutrient adequacy and haemoglobin levels.
Researchers concluded that increasing consumption of pulses, milk, nuts, fruits, vegetables and animal-source foods could significantly improve children’s nutrition. While larger validation studies are needed, researchers believe the tool could eventually be integrated into ICDS and school health programmes, providing a practical method for early detection of hidden hunger and timely dietary counselling.