Minimum Dietary Diversity for Adolescents: Multicountry Analysis to Define Food Group Thresholds Predicting Micronutrient Adequacy among Girls and Boys Aged 10–19 Years

BackgroundAdolescents' diets have been overlooked in nutrition information systems, interventions, and policies. The Minimum Dietary Diversity for Women (MDD-W) indicator has been validated to signal greater micronutrient adequacy among non-pregnant women from low- and middle-income countries, but there is limited evidence for valid food group thresholds among boys or non-pregnant non-lactating girls.MethodsThis multi-country study evaluated the test characteristics of a 10-point food group diversity score (FGDS) – underlying MDD-W – and food group thresholds to predict the micronutrient adequacy of diets from single 24-hour recalls or food diaries (24-HRs) among 83,935 adolescents aged 10-19 years and repeated 24-HRs among 75,480 adolescents from upper-middle and high income countries.ResultsFGDS was lowest among adolescents in lower-middle countries (3.5 ± 1.1) and greatest in high income countries (5.4 ± 1.3 points). Using single 24-HRs, one-point increments in FGDS performed identically to predict higher Mean Adequacy Ratio (MAR) among boys and girls (5.1 percentage points; 95% CI: 5.0-5.2; P 0.60 among adolescents from upper-middle and high income countries, whereas a ≥4 food group cut-off showed superior balance between sensitivity, specificity, and percentage correctly classified in low (only girls) and lower-middle income countries (boys and girls). In contrast, using repeated 24-HRs, the Mean Probability of Adequacy (MPA) levels among adolescents were too high and homogeneous (i.e., all MPAs >0.60) to define an optimal food group threshold.ConclusionMDD-W can be extended to boys and girls aged 10-19 years from upper-middle and high income countries. Furthermore, an adapted indicator using a ≥4 food group threshold signals higher micronutrient adequacy in low and lower-middle income countries. Food group cut-offs to predict the micronutrient adequacy of usual intakes should be validated using repeated 24-HRs in populations where a lower proportion of adolescents meet average dietary requirements.