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Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) Data Collection: Validity of the List-Based and Open Recall Methods as Compared to Weighed Food Record

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Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
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Nutrition and Food Systems Division (ESN), Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy
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Department of Food Science and Nutrition, School of Agricultural Sciences, University of Zambia, P.O. Box 32379 Lusaka, Zambia
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Department of Food Science, Faculty of Agro-Industry, Royal University of Agriculture, P.O. Box 2696 Phnom Penh, Cambodia
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Food Science and Nutrition Research Directorate, Ethiopian Public Health Institute, P.O. Box 1242 Addis Ababa, Ethiopia
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Author to whom correspondence should be addressed.
Nutrients 2020, 12(7), 2039; https://doi.org/10.3390/nu12072039
Received: 3 June 2020 / Revised: 24 June 2020 / Accepted: 8 July 2020 / Published: 9 July 2020
(This article belongs to the Section Nutrition Methodology & Assessment)
Minimum dietary diversity for women of reproductive age (MDD-W) was validated as a population-level proxy of micronutrient adequacy, with indicator data collection proposed as either list-based or open recall. No study has assessed the validity of these two non-quantitative proxy methods against weighed food records (WFR). We assessed the measurement agreement of list-based and open recall methods as compared to WFR (i.e., reference method of individual quantitative dietary assessment) for achieving MDD-W and an ordinal food group diversity score. Applying a non-inferiority design, data were collected from non-pregnant women of reproductive age in Cambodia (n = 430), Ethiopia (n = 431), and Zambia (n = 476). For the pooled sample (n = 1337), proportions achieving MDD-W from both proxy methods were compared to WFR proportion by McNemar’s chi-square tests, Cohen’s kappa, and receiver operating characteristic (ROC) analysis. Ordinal food group diversity (0–10) was compared by Wilcoxon matched-pairs signed-rank tests, intraclass correlation coefficients (ICC), and weighted kappa. MDD-W food groups that were most frequently misreported (i.e., type I and II errors) by the proxy methods were determined. Our findings indicate statistically significant differences in proportions achieving MDD-W, ordinal food group diversity scores, and ROC curves between both proxy methods and WFR (p < 0.001). List-based and open recall methods overreported women achieving MDD-W by 16 and 10 percentage points, respectively, as compared to WFR (proportion achieving MDD-W: 30%). ICC values between list-based or open recall and WFR were 0.50 and 0.55, respectively. Simple and weighted kappa values both indicated moderate agreement between list-based or open recall against WFR. Food groups most likely to be misreported using proxy methods were beans and peas, dark green leafy vegetables, vitamin A-rich fruit and vegetables, and other fruits. Our study provides statistical evidence for overreporting of both list-based and open recall methods for assessing prevalence of MDD-W or ordinal food group diversity score in women of reproductive age in low- and middle-income countries. Operationalizing MDD-W through qualitative recall methods should consider potential trade-offs between accuracy and simplicity. View Full-Text
Keywords: Cambodia; Ethiopia; list-based recall; open recall; minimum dietary diversity for women; weighed food record; Zambia Cambodia; Ethiopia; list-based recall; open recall; minimum dietary diversity for women; weighed food record; Zambia
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Hanley-Cook, G.T.; Tung, J.Y.A.; Sattamini, I.F.; Marinda, P.A.; Thong, K.; Zerfu, D.; Kolsteren, P.W.; Tuazon, M.A.G.; Lachat, C.K. Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) Data Collection: Validity of the List-Based and Open Recall Methods as Compared to Weighed Food Record. Nutrients 2020, 12, 2039.

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