Objective: To examine the associations of dietary diversity with anaemia and iron status among primary school-aged children in South Africa. Design: An analysis was conducted with pooled individual data from the baseline surveys from three previously conducted independent intervention studies. Two different dietary diversity scores (DDS) were calculated based on data from 1-day (1-d) and 3-day (3-d) dietary recall periods, respectively. Logistic regression analysis was performed to examine the associations of dietary diversity with anaemia and iron status. Setting: KwaZulu-Natal and North West provinces, South Africa. Participants: Children (n 578) 5- to 12-year-old. Results: A DDS ≤ 4 was associated with higher odds of being anaemic (1-d P = 0·001; 3-d P = 0·006) and being iron deficient (ID) (3-d P < 0·001). For both recall periods, consumption of 'vegetables and fruits other than vitamin A-rich' and 'animal-source foods (ASF)' was associated with lower odds of being anaemic (both P = 0·002), and 'organ meats' with lower odds of being ID (1-d P = 0·045; 3-d P < 0·001). Consumption of 'meat, chicken and fish' was associated with lower odds of being anaemic (P = 0·045), and 'vegetables and fruits other than vitamin A-rich', 'legumes, nuts and seeds' and 'ASF' with lower odds of being ID for the 3-d recall period only (P = 0·038, P = 0·020 and P = 0·003, respectively). Conclusion: In order to improve anaemia and iron status among primary school-aged children, dietary diversification, with emphasis on consumption of vegetables, fruits and ASF (including organ meats), should be promoted.
Bibliographical noteFunding Information:
Acknowledgements: The authors are grateful to all the research team members and all the participants of the single studies we obtained the data from. Financial support: This article was part of the first author’s doctoral thesis, which was supported by study grants from the South African National Research Foundation (grant no. UID 101720), Nestlé Nutrition Institute Africa (grant 22/06/2016) and Association of African Universities (grant PC/6). The funders had no role in the design, analysis or writing of this article. Conflict of interest: There are no conflicts of interest. Authorship: T.V.Z. and M.F. conceptualised this study and contributed to the writing of the paper; M.V. analysed the data and wrote the draft article; S.M.H., J.B., M.H., C.T.-K. and C.M.S. were responsible for data collection in the original studies and contributed to the writing of the paper. All authors read and approved the final manuscript. Ethics of human subject participation: This study did not involve human subjects and was conducted with pooled existing data derived from three independent intervention studies. All original intervention studies were conducted according to the guidelines laid down in the Declaration of Helsinki, and all the procedures involving research study participants were approved by the appropriate ethics committees before data collection. Additional approval from the Health Research Ethics Committee was obtained to perform the present study (NWU-00027-16-A1).
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- Dietary diversity
- Iron deficiency
- School-aged children
- South Africa