Background: Quantitative dietary assessment is hindered by cost, time, and logistical burdens. Collecting 24-hour recall (24HR) dietary data by phone may be particularly advantageous in rural areas. Objectives: To assess the criterion and relative validity and costs of phone compared with in-person 24HR versus observed weighed food records (WFR), a reference measure for true intake. Methods: We used a randomized crossover design to collect phone and in-person 24HRs from 103 rural Sri Lankan adults, each matched to a WFR collected on the reference day. Agreement was assessed using equivalence testing with 15% error bounds and concordance correlation coefficients. Memory and portion size estimation errors were examined using descriptive statistics. Activity-based costing was used to estimate 24HR costs using expenditures and micro-costing. Results: Compared with WFR, respondents underreported energy intake by 263 kcal (12.6%) in phone 24HR and 229 kcal (10.9%) in in-person 24HR, primarily due to portion size misestimation. Mean intakes of protein and 6 micronutrients were equivalent between phone 24HR and WFR. Although no nutrients were equivalent for in-person recalls, the two recall methods had relative equivalence for energy, carbohydrates, fat, zinc, and niacin. The mean concordance correlation coefficient was slightly higher for phone recalls, whereas memory error was lower for in-person recalls. Costs per respondent were $254 for in-person 24HR and $186 for phone 24HR in a most likely implementation scenario. Conclusions: Among rural Sri Lankan adults, phone-based 24HR were comparable to in-person 24HR in estimating nutrient intakes, although both methods underestimated true intakes. Phone-based recalls were less expensive and performed at least as accurately as those collected in-person.

Dietary intake data are essential for understanding diet-disease relationships, informing policy, and evaluating nutrition interventions. This is particularly challenging in population- and community-based research, where varying dietary patterns, motivation to participate, and practical constraints limit the feasibility of highly controlled dietary assessment methods. Advances in digital tools, including web- and smartphone-based assessment, image- and speech-based methods, wearable sensors, and artificial intelligence are transforming how dietary data are collected, processed, and analyzed. This narrative review examines how digital and technology-enabled approaches impact key sources of bias and error throughout the stages of dietary assessment, from sample selection and participant reporting to food classification and nutrient composition assignment. We also assess the feasibility of implementing these approaches in large-scale research settings by considering resource requirements, respondent burden, and scalability. Evidence supporting these technologies varies considerably across applications, populations, and settings, and relatively few approaches have been evaluated in large-scale or low-resource research contexts. Although many technologies can reduce specific sources of bias and measurement error, they may also introduce new challenges, such as selection bias and higher development or implementation costs. These trade-offs are especially pronounced in large and heterogeneous study populations. Constraints related to connectivity, device access, and technical capacity may further limit implementation in low-resource settings. While technological innovations offer significant opportunities to improve dietary assessment, selecting the appropriate assessment method requires careful consideration of the trade-offs between accuracy and feasibility in the intended research context.

BACKGROUND:Reliable dietary data for adolescents in low- and middle-income countries (LMICs) are limited due to high costs and estimation errors in traditional dietary assessment methods. Although technology-assisted dietary assessment tools are becoming popular, few have been validated in LMICs. OBJECTIVES:This study validated the PlantVillage Food Recognition Assistance and Nudging Insights (FRANI), an artificial intelligence-assisted mobile application for dietary assessment, against weighed food records (WFR) and multipass 24-h recalls (24HR) among adolescent girls aged 14‒18 y (n = 60) in urban/semi-urban communities in Sri Lanka. METHODS:Dietary intake was assessed over 2 non-consecutive days using 3 methods: FRANI, WFR, and 24HR. The equivalence of nutrient intake was evaluated using mixed-effect models accounting for repeated measures by comparing intake ratios (FRANI/WFR and 24HR/WFR) with 10%, 15%, and 20% equivalence bounds. The concordance correlation coefficient was utilized to assess the agreement between methods. RESULTS:FRANI demonstrated equivalence with WFR at the 10% bound for energy and vitamin A; 15% for protein, fiber, iron, and zinc; and 20% for fat, niacin, and folate intakes. Comparisons between 24HR and WFR found that no nutrients fell within the 10% bound. Energy, protein, fat, iron, niacin, and vitamin A intakes were equivalent at 15% bound, whereas fiber, calcium, folate, and vitamin C intakes were equivalent at 20% bound. Concordance correlation coefficient ranged from 0.49 to 0.89 for FRANI compared to WFR, and 0.44 to 0.84 for 24HR compared with WFR. Omission errors were 2% for FRANI and 12% for 24HR, and intrusion errors were 7% and 9%, respectively. CONCLUSIONS:PlantVillage FRANI application accurately estimated nutrient intakes of adolescent girls in Sri Lanka compared to the WFR. Its performance was at least comparable to the traditional 24HR method, supporting its potential as a scalable alternative for dietary assessment in similar LMIC populations.

BACKGROUND:Diet-related challenges and food insecurity are experienced by many Filipinos, underscoring the need for evidence-based interventions to improve diet quality and prevent malnutrition. OBJECTIVES:The study aimed to evaluate the usual energy and nutrient intakes and the probability of inadequate micronutrient intake across different population groups in the Philippines. METHODS:The 2021 Expanded National Nutrition Survey (ENNS) was a nationally representative survey conducted in the Philippines; it assessed dietary intake using a quantitative 24-h dietary recall, with a repeated recall among 50% of participants on nonconsecutive days. Usual intakes, probability of inadequate intake (PII) for micronutrients, and mean probability of inadequacy (MPI) for 11 micronutrients were estimated using the National Cancer Institute method among children under-5 (U5, n = 4930), school-aged children (SAC; 6-9 y, n = 8116), adolescents (10-19 y, n = 15,394), adults (20-59 y, n = 29,391), elderly (>60 y, n = 9170), nonpregnant/nonlactating women of reproductive age (NPNL-WRA; 15-49 y, n = 15,037), pregnant females (n = 436), and lactating females (n = 1354). RESULTS:Mean energy intake ranged from 699 kcal/d in U5 to 1500 kcal/d in adults and was below recommendations across all populations. Carbohydrates contributed 61% of energy in U5 and 73% in adults and lactating females. Protein contributed 12% to 14% and fat 13% to 26% across all groups. High PII (>75%) for calcium, zinc, vitamin C, riboflavin, iron, thiamine, and folate was observed in most groups, except for lower inadequacies in thiamine, folate, vitamin B6, and vitamin B12 among U5 and SAC. MPI increased with age, from 59.5% in U5 to 83.3% in lactating females and was higher among groups from food-insecure households. CONCLUSIONS:Reported energy intake was below recommendations in most groups. Intake of many micronutrients was inadequate, particularly among NPNL-WRA, pregnant, and lactating women, highlighting the urgent need for targeted interventions to improve dietary quality, micronutrient intake, and food security among vulnerable populations.

Maternal depression affects one in five women in Malawi. Integrated interventions simultaneously addressing multiple risks are a promising strategy to improve mental health. This study evaluated the impact of a nutrition-sensitive social behaviour change (SBC) intervention (agriculture and livelihoods, male engagement and Caring for the Caregiver) with or without cash transfers on maternal perinatal depression during the lean season in rural Malawi. A midline survey for a cluster-randomised controlled trial was conducted, where 156 clusters were randomly assigned to four arms (39 clusters/arm): (1) standard of care (SoC), (2) SBC, (3) SBC+low cash (US$17 per month) and (4) SBC+high cash (US$43 per month). Pregnant women and mothers of children <2 years of age (n=2677) were enrolled at baseline (May–June 2022). A subsample of 1303 women was followed-up at midline (November–December 2023). Maternal perinatal depression was assessed using the Self-Reporting Questionnaire with a score of ≥8 indicating symptoms consistent with depression. Intervention effects were estimated using linear mixed effects models. At midline, SBC+high cash reduced depression scores relative to SoC (mean difference −1.13 (95% CI −1.96 to –0.31)) but had no impact on the proportion of women with depressive symptoms. Relative to SoC, SBC+low cash and SBC alone had no impact on depression scores or the proportion of women with depressive symptoms. Relative to SBC alone, adding cash to SBC reduced depression scores and the proportion of women with depressive symptoms regardless of the size of the cash transfer. Cash transfers integrated with SBC can benefit maternal perinatal mental health in rural Malawi during the lean season. Trial registration number ISRCTN53055824.

Objective: The double burden of malnutrition (DBM) - the coexistence of undernutrition and overweight/obesity - poses a critical global health challenge, particularly for children and adolescents. School meal programmes offer an opportunity to address the DBM by providing nutritious meals that support growth, development and lifelong health. However, limited school meal quality data hinders effective programme design. This study evaluates global school meal quality through nutrient composition analyses and the Global Diet Quality Score (GDQS)-Meal and -Menu metrics.Design: Data were collected from the Global Child Nutrition Foundation's 2024 Global Survey of School Meal Programs, grey literature and in-country stakeholders. Nutritional content was compared to age-specific Nutrient Reference Values, including Harmonized Average Requirements. The nutritional quality of meals and menus was assessed using GDQS metrics based on twenty-five food groups.Setting: Twenty-nine countries across diverse geographic and socio-economic contexts.Participants: Not applicable.Results: Most menus met or exceeded 30 % of recommended daily nutrient values. Lunches had the highest nutrient contributions, followed by snacks and breakfasts. GDQS-Meal and -Menu scores revealed variability across age groups, meal types and countries. Overall, 57 % of menus achieved high nutritional quality, 37 % medium and 6 % low. Few menus lost points for unhealthy components. Diverse, balanced menus with healthy food groups scored higher, though fortification also proved nutritionally valuable.Conclusions: While most menus contribute significantly to daily nutrient needs, variability across countries, age groups and meal types highlights opportunities for context-specific improvements through diversification and fortification. Learning from high-performing peer programmes can help identify feasible improvements.

Background Quantitative dietary assessment is hindered by cost, time, and logistical burdens. Collecting 24-hour recall (24HR) dietary data by phone may be particularly advantageous in rural areas. Objective To assess the criterion and relative validity and costs of phone versus in-person 24HR compared to observed weighed food records (WFR), a reference measure for true intake. Methods We used a randomized cross-over design to collect phone and in-person 24HR from 103 rural Sri Lankan adults, each matched to a WFR collected on the reference day. Agreement was assessed using equivalence testing with 15% error bounds and concordance correlation coefficients. Memory and portion size estimation errors were examined using descriptive statistics. Activity-based costing was used to estimate 24HR costs using expenditures and micro-costing. Results Compared to WFR, respondents underreported energy intake by 263 kcal (12.6%) in phone 24HR and 229 kcal (10.9%) in in-person 24HR, primarily due to portion size misestimation. Mean intakes of protein and six micronutrients were equivalent between phone 24HR and WFR. Although no nutrients were equivalent for in-person recalls, the two recall methods had relative equivalence for energy, carbohydrates, fat, zinc, and niacin. The average concordance correlation coefficient was slightly higher for phone recalls, while memory error was lower for in-person recalls. Costs per respondent were $254 for in-person 24HR and $186 for phone 24HR in a most likely implementation scenario. Conclusions Among rural Sri Lankan adults, phone-based 24HR were comparable to in-person 24HR in estimating nutrient intakes, although both methods underestimated true intakes. Phone-based recalls were less expensive and performed at least as accurately as those collected in person.

Objectives: To optimise school food baskets in Ghana to meet newly proposed food and nutrition targets while considering cultural acceptability and cost.Design: This was a modelling study. Data on existing school meal menus were collected from various regions to provide baseline inputs. Linear programming (LP) was used to model school meal baskets that satisfied minimum nutrient and food targets for school meals while meeting cost and acceptability constraints. Five LP models were tested, each varying in budget constraints and acceptability/food-based parameters.Setting: Ghana.Participants: NA.Results: Baseline school food baskets were significantly deficient in energy, protein, Fe, Zn, vitamin A, folate, vitamin B12 and vitamin C compared to food and nutrient standards for school meals in Ghana. Optimisation resulted in school food baskets that met cost, nutrient and food-based/acceptability targets but with substantial deviations from baseline. Achieving nutritional adequacy within cost limits increased reliance on animal-source foods and led to higher environmental impacts, indicating trade-offs between nutrition, affordability and environmental sustainability.Conclusion: The study underscores LP's potential for enhancing school meals in Ghana but highlights the need for increased financial investment for reaching dietary goals. Addressing local realities and cultural preferences is essential for implementing effective, sustainable school meal strategies and improving child health.

Poverty reduction and nutrition are often joint outcomes of many public policies and programs which have education as their primary outcome. Quantification of overall benefits for these programs in a common metric is challenging. We propose a new method to incorporate distributional benefits from poverty reduction into standard education economic evaluations. We apply this to a randomized controlled trial (RCT) evaluating a large-scale school feeding program in Ghana. We first map effect sizes from the RCT in learning-adjusted years of schooling. We then convert these into long-term monetary gains from increased learning, to which we finally add the distributional benefits under different scenarios of inequality aversion preferences. We show that the program has substantial long-term economic gains. While these primarily stem from improved human capital, depending on different scenarios, up to half of total benefits are driven by current gains from the social protection transfer. Beyond school meals, our methodology is relevant to programs that have impacts covering both human capital and distributional benefits, and to economic evaluations beyond education.

Background The response to the global call for more data on children's and adolescents' diets and nutrition is limited by the lack of straightforward practical indicators to track their diet quality. On the basis of a food group score compiled from 10 food groups (FGS-10), the minimum dietary diversity for women, calculated as FGS-10 >= 5, is a validated proxy population indicator for better micronutrient intake adequacy for adult women in low- and middle-income countries (LMICs). Objectives This study aims to validate FGS-10 and its related cutoffs against micronutrient intake adequacy in 4-15-y-old children/adolescents in LMICs. Methods We conducted a secondary data analysis of 9 datasets of repeated 24-h recalls or weighed records including 11,524 children/adolescents aged 4-15 y, collected in 7 countries (Burkina Faso, Ghana, Ecuador, India, Malawi, Uganda, and Zambia) between 2007 and 2022. For each dataset and the pooled sample (meta-analysis), we assessed the association between FGS-10 and the mean probability of adequacy (MPA) of intake over 8 micronutrients (MPA-8), and the performance of several FGS-10 cutoffs in predicting acceptable (>= 0.60) and good (>= 0.80) levels of MPA-8. Robustness analyses used the 7 datasets with data on 11 micronutrients (MPA-11). Results FGS-10 ranged from 3.0 to 4.8 across datasets, and the proportion of children/adolescents with acceptable MPA-8 ranged from 8.4% to 74%. Positive and significant associations between FGS-10 and MPA-8 were found in all datasets and the pooled sample. The optimal cutoff varied across datasets from FGS-10 >= 4 to FGS-10 >= 6. In the pooled sample, FGS-10 >= 5 had the highest performances in predicting acceptable and good levels of MPA-8. FGS-10 >= 5 was also the best proxy indicator for MPA-11 >= 0.80. Conclusions The continuous FGS-10 and dichotomous FGS-10 >= 5 may be extended to 4-15-y-old children/adolescents in LMICs. In this population, FGS-10 >= 5 can be used as a proxy population indicator for good micronutrient adequacy of diets.

ABSTRACTUndernutrition in women and young children in Burkina Faso is a critical problem. Egg consumption is low despite many households raising poultry. The Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale (SELEVER) project, an integrated agriculture‐nutrition intervention, promoted egg consumption and sales to investigate the impact of poultry production on child nutrition. Multisectoral nutrition‐sensitive agriculture programs address nutrition deficits but lack comparable cost information. This study estimates the costs of the SELEVER program, an integrated poultry and nutrition intervention. The study estimates the program's economic costs using a standardized methodology from the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS‐Nutrition) consortium, which aligns financial and economic costs along program impact pathways, allocating costs by activities and inputs. We conducted qualitative interviews and focus groups on time allocation and beneficiary out‐of‐pocket costs. Incremental economic costs were calculated by combining expenditures and economic costs. The total incremental program cost was USD$18,084,727.68 over 5 years, with annual incremental costs of USD$209.20 per direct beneficiary and $796.26 per household. Major cost drivers included overhead (18%), poultry extension (17%), training (16%), household counseling (7%), technical assistance (7%) and microcredit (6%). Total input costs were dominated by personnel (51%), supplies (13%), agricultural inputs (10%) and overhead (9%). We present the total incremental costs of a multisectoral nutrition intervention to generate revenue with poultry. The costs per beneficiary were higher than similar interventions, underscoring the need for cost‐effectiveness evaluations of multisectoral nutrition programs. A standardized cost methodology facilitates comparisons with multisectoral nutrition interventions and builds the evidence base.

BACKGROUND:Two billion children globally are estimated to live in conflict-affected areas. School feeding programs (SFPs) are a widely implemented safety net that supports children during and after conflict. OBJECTIVES:We evaluated the effectiveness of providing milk alongside a high-energy biscuit (HEB) SFP in Yemen on children's and caregivers' outcomes. METHODS:We implemented a 2-arm longitudinal cluster-randomized controlled trial from December 2023 to May 2024. Forty-two schools in Al Mukha district were randomly assigned (1:1) to control, where children received HEBs (2 packets [100 g] daily), or milk, where children received HEBs plus a 120 mL carton of ultra-high temperature milk. Children aged 6-18 y were randomly selected for enrolment. The primary outcomes were children's dietary diversity and milk consumption. Secondary outcomes were children's cognition, learning, attendance, nutritional status, and health. Tertiary outcomes were child and caregiver mental health and household food security. We conducted intent-to-treat analysis using linear mixed-effects models accounting for clustering. RESULTS:One thousand two hundred ninety-nine children were enrolled. After 5 mo, the intervention increased milk consumption but had no effect on dietary diversity. Children's cognition [mean difference (MD): 1.00 (95% CI: 0.40, 1.61)], literacy [MD: 1.14 (95% CI: 0.36, 1.92)], and numeracy [MD: 1.06 (95% CI: 0.46, 1.67)] scores improved. Cough symptoms declined: MD: -0.12 (95% CI: -0.2, -0.03). There were no changes in school attendance or nutritional status. The intervention reduced conduct problems in children [MD: -0.52 (95% CI: -0.97, -0.08)], severe anxiety in caregivers [MD: -0.03 (95% CI: -0.06, -0.001)], and household severe food insecurity [MD: -0.09 (95% CI: - 0.17, -0.001)]. CONCLUSIONS:Adding a daily milk drink to an HEB SFP in Yemen resulted in numerous benefits for children and their families. Hybrid models to incrementally improve meal quality are feasible, acceptable, and lead to meaningful impacts. More research is needed on medium- and long-term benefits. REGISTRATION:The trial was registered with ISRCTN (ISRCTN12225603).

Abstract Objective To characterize food group consumption, assess the contribution of food groups to energy and micronutrient intake, and estimate usual nutrient intake among adults in rural Sri Lanka. Design A baseline survey (Dec 2020–Feb 2021) was conducted as part of an agriculture-based, nutrition-sensitive resilience program evaluation. Dietary intake was assessed using telephone-based 24-hour recalls (n=1283), with repeat recalls from 769 participants. Mean daily intake of food groups and their contribution to energy and nutrient intakes were calculated. The National Cancer Institute method was used to estimate usual intakes and the prevalence of adequate micronutrient intake (PAI). Differences by sex, district, and wealth were assessed using t-tests and ANOVA. Setting Forty-five rural villages throughout Sri Lanka. Participants Men and women from households in the program evaluation study area. Results On average, grains and coconut milk provided 56% and 12% of energy, respectively. Rice, fish, dairy, and pulses were the primary sources of micronutrients. Participants consumed 118±117g vegetables and 71±243g fruit per day. PAI was <25% for calcium; zinc; niacin; folate; and vitamins B6, B12, and C, reflecting low consumption of animal-source foods (ASF; 80 g/day), whole grains, fruits, and vegetables (F&V). Significant differences in food group consumption by sociodemographic subgroup were observed among districts and wealth quintiles. Conclusions We observed high consumption of rice and coconut milk and low prevalence of micronutrient adequacy. We recommend increasing ASF, whole grain, and F&V consumption to close nutrient gaps, as well as research to identify effective solutions to increase micronutrient intake.

OBJECTIVE:The purpose of the study was to develop and validate a Global Diet Quality Score (GDQS) for children aged 5-9 years adapted from the existing GDQS developed for adults. BACKGROUND:Diet quality is important for nutrient adequacy and risk of nutrition-related chronic disease. A diet quality metric for global use with children is needed. METHODS:The 25 food groups of the GDQS were used to assign points for categories of consumption according to gram-weight cutoffs adapted for children based on energy requirements. As a preliminary step, alternative versions of gram-weight cutoffs were tested by comparing correlation analyses using 4 existing dietary datasets from low-, middle-, and high-income countries. A final GDQS metric version, selected based on strength of correlations and operational feasibility, was further examined in regression analyses with individual nutrient intake an overall nutrient intake adequacy score and biomarker and anthropometry outcomes in 7 dietary datasets from different countries. Regressions were also undertaken with other diet quality metrics to compare their relative performance with that of the GDQS. RESULTS:The GDQS had strong associations with most nutrient intakes, including an overall mean nutrient adequacy score and some nutrients associated with noncommunicable disease risk, such as fiber and added sugar. Biomarker data were limited in the available datasets and few associations with GDQS were found. The GDQS performed better or as well as other dietary quality metrics in predicting nutrient intakes. CONCLUSION:The GDQS was associated with nutrient intakes and fills a gap in a global diet quality metric for children. The GDQS will be a useful tool to measure diet quality and monitoring changes in diet quality over time.

OBJECTIVES:To develop the Global Diet Quality Score (GDQS) for children aged 24-59 months and evaluate its performance in predicting outcomes related to nutrient adequacy and diet-related noncommunicable disease (NCD) risk. BACKGROUND:The GDQS is a food-based metric developed and validated for capturing diets' contributions to nutrient adequacy and NCD risk among adult men and nonpregnant and nonlactating women aged ≥15 years globally. Despite the importance of ensuring healthy diets in preschool children and the need for systematic monitoring, no food-based metrics exist that holistically measure diet quality among children aged 24-59 months in diverse populations. METHODS:We developed candidate versions of the GDQS for children aged 24-59 months by adapting the gram cutoff values used for adults to account for children's lower energy requirements. Using dietary data sets from Bangladesh, Burkina Faso, China, Ethiopia, Mexico, the United Kingdom, and the United States, we evaluated candidate versions' performance in predicting energy-adjusted nutrient intakes and adequacy, nutritional biomarkers, and overweight using Spearman's correlation and multivariable-adjusted regression models, and we statistically compared performance of the strongest candidate with that of the Minimum Dietary Diversity-Women (MDD-W) indicator and Global Dietary Recommendations (GDR) score. RESULTS:The GDQS exhibited significant (P < .05) positive correlations with energy-adjusted intakes of protein, fiber, and most micronutrients in most data sets; significant negative correlations with added sugar and saturated fat in 2 data sets; and inconsistent correlations with monounsaturated and polyunsaturated fat. In multivariable-adjusted models, the GDQS, MDD-W, and GDR were positively associated with serum folate in Ethiopia (and the GDQS was in the United Kingdom), and the GDR was positively associated with high-density lipoprotein cholesterol in China (P < .05). The GDQS was more strongly associated with the mean probability of adequacy of 8 nutrients than the GDR in 2 data sets, whereas the MDD-W outperformed the GDQS in 3 data sets (P < .05). CONCLUSION:The GDQS is a useful metric for measuring diet quality among children aged 24-59 months in diverse populations.

OBJECTIVE:We aimed to evaluate the performance of the Global Diet Quality Score (GDQS) in predicting nutrient intake and health outcomes among children aged 10-14 years old in Mexico, the United States, the United Kingdom, and China. For comparison, we evaluated other dietary metrics (Minimum Dietary Diversity for Women [MDD-W], the Global Dietary Recommendations score [GDR], and the Healthy Eating Index-2020 [HEI-2020]). BACKGROUND:Given the magnitude of the health burden associated with all forms of malnutrition, monitoring dietary quality is fundamental to improving global health. Early adolescence is a key stage of development, and thus validated tools to measure diet quality that are pertinent for the global context are needed. METHODS:The GDQS and comparison metrics were estimated from 24-hour dietary recalls (Mexico: n = 2533; United States: n = 685; China: n = 1087, and United Kingdom: n = 1675). Regression models were conducted to evaluate the association between the change in 1 SD of each metric score and usual intake of nutrients, mean probability of nutrient adequacy, and biomarker and anthropometric outcomes adjusted by age, sex, socioeconomic status, educational level, urban/rural area, and usual energy intake (for dietary outcomes). RESULTS:The GDQS showed a higher diet quality in China (16.7 points) and Mexico (15.9 points), followed by the United States (13.6 points) and the United Kingdom (12.2 points). The GDQS was found to be associated with the intake of micronutrients as well as noncommunicable disease (NCD)-related nutrients (fiber, added sugar, and saturated fat) (P < .05). The performance of the GDQS was comparable to all other metrics; yet, in the case of NCD-related nutrients the MDD-W was slightly inferior. Few associations were found across countries and metrics with biomarker and anthropometric outcomes. CONCLUSION:The GDQS was associated with the intake of micronutrients and NCD-related nutrients; these results suggest that the GDQS is an appropriate tool to monitor dietary quality among 10-14-year-olds across several contexts globally.

BACKGROUND:Livestock production interventions can improve consumption of animal-source foods and diet diversity, which may lead to improved micronutrient adequacy. OBJECTIVES:We assessed the effectiveness on maternal and child dietary outcomes of "Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale" (SELEVER), a livestock intervention designed to improve diets in rural Burkina Faso through training and market facilitation to improve poultry production; females' empowerment activities; and nutrition and hygiene behavior change communication. METHODS:For a nonblinded cluster-randomized controlled trial, we randomly assigned 30 communes to SELEVER and 30 communes to control, of which 15 communes served as control for a narrow sample. Fifteen households were randomly selected in 2 villages per commune; of which 12 were included in the narrow sample. In the wide sample, we used analyses of covariance to assess SELEVER's effectiveness on dietary diversity in index children aged 2-4 y at baseline and in their caregivers, and on minimum acceptable diet in their siblings aged 6-23 mo at measurement. In the narrow sample, we used difference-in-difference to assess SELEVER's effectiveness on vitamin A, iron, and zinc prevalence of adequate intakes (PA) and mean PA of 11 micronutrients in index children and caregivers. RESULTS:We enrolled 1767 index children, 1766 caregivers, and 412 siblings aged 6-23 mo at endline in the wide sample, and 1054 caregiver-child dyads in the narrow sample. In the wide sample, exposure to program activities was higher but moderate in SELEVER communities, with limited effects on dietary knowledge and practices and no effects on diet outcomes. The narrow sample showed a negative effect on zinc PA in children (-26 percentage points, P = 0.020), and no effect on other outcomes. CONCLUSIONS:A program focused on improving the productivity of and demand for nutritious foods did not improve micronutrient adequacy. Implementation strategy and bottlenecks may have limited the system transformations needed to produce measurable shifts toward healthier diets. TRIAL REGISTRATION NUMBER:This study was registered at ISCRCTN with registration number ISRCTN16686478 (https://www.isrctn.com/ISRCTN16686478).