Dietary diversity and nutrient adequacy among women in Bosomtwe District, Ghana

The sustainable development goals seek to end all forms of malnutrition of women of reproductive age (WRA) by 2030. As such, recent data on nutrient adequacy are needed to aid in tracking progress. However, data on specific dietary nutrient intakes includes only iron, folate, vitamin A, and vitamin B-12 in Ghana. Therefore, women's dietary diversity score (W-DDS) is often used as a proxy measure of nutrient adequacy. It is hypothesised that there is no association between W-DDS and Nutrient Adequacy among WRA in peri-urban Ghana. Hence, this research evaluated the associations between W-DDS and nutrient adequacy ratio (NAR) and assessed the determinants of mean nutrient adequacy ratio (MAR) in the Bosomtwe District of Ghana. A community-based cross-sectional study was conducted, and data collected on anthropometry, food insecurity, socio-demographic characteristics and dietary intake using the 24-hour recall from 407 WRA. In all, 21 nutrients were assessed. The mean age, W-DDS, and MAR were 29.0 +/- 6.7 years, 5.3 +/- 1.9, and 0.65 +/- 0.19 respectively. The NAR were generally high for the macronutrients as compared to micronutrients and the nutrients with low NAR included vitamin C (0.27 +/- 0.19), vitamin A (0.15 +/- 0.23), vitamin B-12 (0.54 +/- 0.32), calcium (0.28 +/- 0.20), zinc (0.52 +/- 0.23) and iron (0.57 +/- 0.28) - signifying the WRA may be consuming monotonous carbohydrate-based diet. The hierarchical multivariable linear regression found a significant association between W-DDS and MAR after controlling for confounders (beta = 0.404, p < 0.001). The determinants of MAR were ethnicity (beta = 0.110, p = 0.006) and body mass index (beta = 0.189, p < 0.001). This study supports the use of W-DDS as a proxy indicator of nutrient adequacy. Strategies meant to address nutrient inadequacies should be adaptable to different ethnic groups and overweight-reducing strategies should be incorporated into broader nutrition initiatives.