Minimum Dietary Diversity is Associated with Lower Risk of Childhood Underweight: Evidence from the 2019/21 National Family Health Survey of India

A lack of consumption of a diversified diet is associated with poor physical and cognitive development in children, with a negative long-term impact on their educational achievements and productivity. Evidence on the relationship between minimum dietary diversity (MDD) and childhood malnutrition remains inconclusive in India. We hypothesized that children aged 6–23 months on a diversified diet (five out of eight defined foods and beverages) are less likely to be malnourished (stunting, wasting, and underweight) compared to their counterparts who are not on a diversified diet. This cross-sectional study was based on the 2019-21 National Family Health Survey (NFHS) of India, comprising a weighted sample of 57,714 children aged 6–23 months. MDD was defined as a child consuming five or more food categories (MDD ≥ 5) out of the eight food groups recommended by the WHO's Guideline for Infant and Young Children aged 6-23 months on the previous day. Multilevel logistic regression was used to examine the association between dietary diversity and childhood stunting, wasting, and underweight. The results showed a significant protective effect of dietary diversity on underweight (OR = 0.91; 95% CI: 0.86–0.96). In addition, children who did not consume eggs (OR = 1.09; 95% CI; 1.03–1.15), dairy products (OR = 1.22; 95% CI: 1.17–1.27), or fruits and vegetables (OR = 1.11; 95% CI: 1.06–1.17) were more likely to be underweight than children who did. Children who did not consume dairy products, fruits and vegetables were also more likely to be stunted and wasted. However, we did not find significant associations of MDD with wasting and stunting. This study highlighted the need for nutritional interventions that promote daily consumption of dairy products, eggs, fruit, and vegetables to address the growing problem of childhood malnutrition in India. Regions with higher rates of malnutrition and those lacking MDD, such as Uttar Pradesh and Rajasthan, should be prioritized.