Associations between dietary diversity and micronutrient status of children aged 6–23 months in rural Burkina Faso and Kenya: cross-sectional findings from the ALIMUS study

Objective This study examined the associations between dietary diversity, food variety and micronutrient status among young children in rural Burkina Faso and Kenya. Methods Cross-sectional baseline data from 1307 children aged 6–23 months from a cluster-randomised controlled trial, the ALIMUS–“We are feeding” study, were analysed. The Dietary Diversity Score (DDS), Minimum Dietary Diversity (MDD) and Food Variety Score (FVS) were assessed using a food propensity questionnaire. Nutrient adequacy ratios for iron, zinc, selenium and vitamin A, and the mean adequacy ratio (MAR) were calculated. We calculated prevalence ratios (PRs) with 95% CIs for the associations between dietary indicators and micronutrient adequacy using a modified Poisson regression model. Receiver operating characteristic analysis was used to determine optimal cut-offs for DDS and FVS to predict MAR. Results 89% of the children (median age: 16 months, IQR: 11, 20; boys: 51.6%) met MDD, with a higher prevalence in Kenya (95.1%, 95% CI 93.2% to 96.5%) than in Burkina Faso (82.8%, 95% CI 79.7% to 85.6%). Higher DDS and FVS were associated with living in smaller households, higher levels of maternal education and maternal employment. Children who met MDD had a significantly higher prevalence of adequate intakes of iron (PR=16.0), vitamin A (PR=3.5), zinc (PR=1.7) and selenium (PR=1.2). DDS ≥6.5 and FVS ≥20.5 were optimal cut-offs for predicting MAR (area under the curve: 0.89 and 0.91, p<0.001, respectively). Conclusions Higher dietary diversity appears to enhance micronutrient adequacy, which supports the promotion of dietary diversification.