Validity of Dietary Diversity Score as an Indicator of Nutrient Adequacy among Older Adults in Pasay City, Philippines

Charlene Bridgitte C. Cokieng,1 Louie Amado R. Gutierrez,1 Angelica Noelle P. Manaloto,1
Janel Priscilla C. See,1 Jolene Hannah C. Tan1 and Ernani R. Bullecer2

1College of Public Health, University of the Philippines Manila
2Department of Nutrition, College of Public Health, University of the Philippines Manila

Objective. The study was conducted to determine the validity of Dietary Diversity Score (DDS) as an alternative indicator for nutrient adequacy among older adults in Pasay City, Philippines.

Methods.  An analytic cross sectional study design was used on a representative sample of older adults (n = 82) in all barangays under the Doña Marta Health Center in Pasay City. A 5-stage multiple pass single 24-hour food recall was performed to determine the dietary intake of each respondent. Subject's nutrient intake was obtained using the FCT+Menu Eval software. Nutrient Adequacy Ratio (NAR) was then computed using the ratio of subject’s nutrient intake to the Recommended Energy and Nutrient Intakes (RENI) for Filipinos.  The Mean Adequacy Ratio (MAR) was then obtained by computing for the average of the NARs, expressed as a ratio ranging from 0 – 1. Dietary Diversity Score was calculated using the DDS Questionnaire recommended by the FAO Guideline. For the statistical analysis, Pearson's correlation was used to determine the relationship between MAR and DDS. ROC curve analysis was done to determine the most appropriate cut-off points for using DDS among the older adults.

Results.  The selected older adults of Pasay City had a mean DDS of 4.15 (0.14) and a mean MAR of 0.64 (0.02). There was a significant and strong correlation between MAR and DDS (r = 0.519; P < 0.0001). When maximizing sensitivity and specificity, the best cut-off points for achieving a MAR equivalent to both 0.5 and 0.7 were between DDS 4 and 5.

Conclusion. DDS may be used as an indicator of nutrient adequacy among the randomly selected older adults.

Key Words: dietary diversity score, nutritional adequacy, older adults, mean adequacy ratio, nutrient adequacy ratio