Factors Associated with Dietary Diversity Among Preschool Children Aged Two to Six From Low-income Households in Seremban, Malaysia

Main Article Content

Yee Xuen Miow
Jia Hui Ng
Wan Ying Gan
Geeta Appannah

Abstract

Dietary diversity is crucial for children’s growth, development, and overall health status, particularly for those aged two to six. However, studies on dietary diversity among young children in Malaysia are limited. This cross-sectional study aimed to determine the factors associated with dietary diversity among preschool children aged two to six years old from low-income households in Seremban. Materials and methods: A total of 245 children from 10 randomly selected Taska KEMAS and 30 randomly selected Tabika KEMAS in Seremban were participated in this study. Mothers completed a questionnaire on socio-demographic background and food security status. Anthropometric measurements, including weight and height, were taken following standardized procedures. A 3-day 24-hour dietary recall of the children was conducted through online interviews with their mothers to assess dietary diversity and nutrient intake. Results: Food insecurity was experienced by 53.9% of the households. The prevalence of underweight, stunting, and wasting among children were 23.3%, 29.4%, and 23.7%, respectively. The mean Dietary Diversity Score (DDS) was 6.34±0.64, with 20.0% were in the lowest DDS tertile. Multiple linear regression analysis showed that mother’s age (β=-0.019, 95% CI=-0.035, -0.002, p<0.05), protein intake (β=0.023, 95% CI=0.012, 0.033, p<0.001), and fat intake (β=-0.023, 95% CI=-0.032, -0.013, p<0.001) were significantly associated with dietary diversity among preschool children. Conclusion: These findings highlight the importance of targeted interventions to address food insecurity, promote balanced diets, and educate mothers to include a variety of nutrient-rich foods to improve dietary diversity of preschool children in low-income households.

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How to Cite
Miow, Y. X., Ng, J. H., Gan, W. Y., & Appannah, G. (2025). Factors Associated with Dietary Diversity Among Preschool Children Aged Two to Six From Low-income Households in Seremban, Malaysia. Malaysian Journal of Medicine and Health Sciences, 21(4), 119–127. https://doi.org/10.47836/mjmhs.21.4.16
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Original Articles

References

Kennedy GL, Pedro MR, Seghieri C, Nantel G, Brouwer ID. Dietary diversity score is a useful indicator of micronutrient intake in non-breast-feeding Filipino children. J Nutr. 2007;137(2):472–477. doi: 10.1093/jn/137.2.472.

Kennedy G, Ballard T, Dop M. Guidelines for measuring household and individual dietary diversity. Nutrition and Consumer Protection Division, Food and Agriculture Organization of the United Nations; 2010.

Arimond M, Ruel MT. Dietary diversity is associated with child nutritional status: Evidence from 11 Demographic and Health Surveys. J Nutr. 2004;134(10):2579–2585. doi: 10.1093/jn/134.10.2579.

Khamis AG, Mwanri AW, Ntwenya JE, Kreppel K. The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatr. 2019;19(1):518. doi: 10.1186/s12887-019-1897-5.

Gassara G, Chen J. Household food insecurity, dietary diversity, and stunting in Sub-Saharan Africa: A systematic review. Nutrients. 2021;13(12):4401. doi: 10.3390/nu13124401.

Hasanah A, Kharisma B, Remi SS, Adam AM, Siregar AYM. Food diversity: Its relation to children’s health and consequent economic burden. BMC Public Health. 2024;24(1):1155. doi: 10.1186/s12889-024-18530-w.

United Nations Children’s Fund. Fed to Fail? The Crisis of Children’s Diets in Early Life [Internet]. UNICEF; 2021.

Kumar R, Mahmood T, Naeem N, Khan SA, Hanif M, Pongpanich S. Minimum dietary diversity and associated determinants among children aged 6-23 months in Pakistan. Sci Rep. 2024;14(1):2639. doi: 10.1038/s41598-024-51705-4.

Moga Lencha F, Jebero Zaza Z, Ena Digesa L, Mulatu Ayana T. Minimum dietary diversity and associated factors among children under the age of five attending public health facilities in Wolaita Soddo town, Southern Ethiopia, 2021: A cross-sectional study. BMC Public Health. 2022;22(1):2368. doi.org/10.1186/s12889-022-14861-8.

Mrema JD, Nyaruhucha CN, Mwanri AW. Dietary intake and diversity among children of age 6-59 months in lowland and highland areas in Kilosa District in Morogoro, Tanzania. Nutr Metab. 2023;33:200205. doi: 10.1016/j.hnm.2023.200205.

Assefa D, Belachew T. Minimum dietary diversity and associated factors among children aged 6-23 months in Enebsie Sar Midir Woreda, East Gojjam, North West Ethiopia. BMC Nutrition. 2022;8(1):149. doi.org/10.1186/s40795-022-00644-2.

Endawkie A, Asmare L, Alemu HT, Geberu DM, Hagos A, Jejaw M, et al. Trend and determinants of minimum dietary diversity consumption change among children aged 6-23 months in Ethiopia from 2011 to 2019: A multivariate decomposition analysis. PLoS ONE. 2024;19(8):e0308349.

Saha J, Chouhan P, Malik NI, Ghosh T, Das P, Shahid M, et al. Effects of dietary diversity on growth outcomes of children aged 6 to 23 months in India: Evidence from National Family and Health Survey. Nutrients. 2022;15(1):159. doi:10.3390/nu15010159.

Rahman MA, Kundu S, Rashid HO, Tohan MM, Islam MA. Socio-economic inequalities in and factors associated with minimum dietary diversity among children aged 6-23 months in South Asia: A decomposition analysis. BMJ Open. 2023;13(12):e072775. doi: 10.1136/bmjopen-2023-072775.

Vilar-Compte M, Burrola-Méndez S, Lozano-Marrufo A, Ferré-Eguiluz I, Flores D, Gaitán-Rossi P, et al. Urban poverty and nutrition challenges associated with accessibility to a healthy diet: A global systematic literature review. Int J Equity Health. 2021;20(1):40. doi: 10.1186/s12939-020-01330-0.

Murtaza SF, Gan WY, Sulaiman N, Mohd Shariff Z, Ismail SIF. Sociodemographic, nutritional, and environmental factors are associated with cognitive performance among Orang Asli children in Malaysia. PLoS ONE. 2019;14(7):e0219841. doi: 10.1371/journal.pone.0219841.

Keno S, Bikila H, Shibiru T, Etafa W. Dietary diversity and associated factors among children aged 6 to 23 months in Chelia District, Ethiopia. BMC Pediatrics. 2021;21(1):565. doi: 10.1186/s12887-021-03040-0.

Rai RK, Kumar SS, Kumar C. Factors associated with minimum dietary diversity failure among Indian children. J Nutr Sci. 2022;11:e4. doi: 10.1017/jns.2022.2.

Antwi J, Quaidoo E, Ohemeng A, Bannerman B. Household food insecurity is associated with child’s dietary diversity score among primary school children in two districts in Ghana. Food Nutr Res. 2022;66. doi: 10.29219/fnr.v66.7715.

Chua EY, Zalilah MS, Chin YS, Norhasmah S. Dietary diversity is associated with nutritional status of Orang Asli children in Krau Wildlife Reserve, Pahang. Malays J Nutr. 2012;18(1):1–13.

Devindran D, Ulaganathan V, Oeh ZY, Tan LX, Kuralneethi S, Eng ZYE, et al. Association between dietary diversity and weight status of aboriginal primary school children in Negeri Sembilan, Malaysia. Malays J Med Sci. 2022;29(1):101–112.

Tiew KF, Chan YM, Lye MS, Loke SC. Factors associated with dietary diversity score among individuals with Type 2 Diabetes Mellitus. J Health Popul Nutr. 2014;32(4):665–676.

Lemeshow S, Hosmer Jr DW, Klar J, Lwanga SK. Adequacy of sample size in health studies. John Wiley & Sons; 1990.

Gicevic, S. Dietary diversity, dietary quality and sustainable dietary surveillance. Harvard University; 2018.

Department of Statistics Malaysia. Household income and basic amenities survey report 2019. Department of Statistics, Malaysia; 2020.

Blumberg SJ, Bialostosky K, Hamilton WL, Briefel RR. The effectiveness of a short form of the Household Food Security Scale. Am J Public Health. 1999;89(8):1231–1234. doi: 10.2105/AJPH.89.8.1231.

Mesbah SF, Sulaiman N, Shariff ZM, Ibrahim Z. Does food insecurity contribute towards depression? A cross-sectional study among the urban elderly in Malaysia. International Int. J. Environ. Res. Public Health. 2020;17(9). doi: 10.3390/IJERPH17093118.

World Health Organization. WHO Child Growth Standards. World Health Organization; 2006.

World Health Organization. BMI-for-age (5-19 years). World Health Organization; 2007.

Ministry of Health Malaysia. Malaysian Food Composition Database [Internet]. Ministry of Health Malaysia; 2015 [cited 2024 October 23]. Available from: https://myfcd.moh.gov.my/

Tee ES, Mohd Ismail N, Mohd Nasir A, Khatijah I. Composition of Malaysian foods. Malaysian Food Composition Database Programme, Institute for Medical Research; 1997.

Health Promotion Board Singapore. Food Composition Guide Singapore. Health Promotion Board Singapore; 2003.

Ha K, Song Y. Associations of meal timing and frequency with obesity and metabolic syndrome among Korean adults. Nutrients. 2019;11(10):2437. doi: 10.3390/nu11102437.

Bi J, Liu C, Li S, He Z, Chen K, Luo R, et al. Dietary diversity among preschoolers: A cross-sectional study in poor, rural, and ethnic minority areas of Central South China. Nutrients. 2019;11(3):558. doi: 10.3390/nu11030558.

Meng L, Wang Y, Li T, Loo-Bouwman CA, Zhang Y, Man-Yau Szeto I. Dietary diversity and food variety in Chinese children aged 3-17 years: Are they negatively associated with dietary micronutrient inadequacy? Nutrients. 2018;10(11):1674. doi: 10.3390/nu10111674.

Leonard KGdL. Dietary Diversity Score (DDS) difference among preschool children (PSC) in rural and urban communities. Asia Pacific Journal of Multidisciplinary Research. 2019;7(2):49–55.

Sirasa F, Mitchell L, Harris N. Dietary diversity and food intake of urban preschool children in North‐Western Sri Lanka. Matern Child Nutr. 2020;16(4). doi: 10.1111/mcn.13006.

Agrawal S, Kim R, Gausman J, Sharma S, Sankar R, Joe W, et al. Socio-economic patterning of food consumption and dietary diversity among Indian children: Evidence from NFHS-4. Eur J Clin Nutr. 2019;73(10):1361–1372. doi: 10.1038/s41430-019-0406-0.

Worku T, Gonete KA, Muhammad EA, Atnafu A. Sustainable under nutrition reduction program and dietary diversity among children’s aged 6-23 months, Northwest Ethiopia: Comparative cross-sectional study. Int J Equity Health. 2020;19(1):14. doi: 10.1186/s12939-019-1120-1.

Frempong RB, Annim SK. Dietary diversity and child malnutrition in Ghana. Heliyon. 2017;3(5):e00298. doi: 10.1016/j.heliyon.2017.e00298.

Jayawardena R, Byrne NM, Soares MJ, Katulanda P, Yadav B, Hills AP. High dietary diversity is associated with obesity in Sri Lankan adults: An evaluation of three dietary scores. BMC Public Health. 2013;13(1):314. doi: 10.1186/1471-2458-13-314.

Zhao W, Yu K, Tan S, Zheng Y, Zhao A, Wang P, et al. Dietary diversity scores: An indicator of micronutrient inadequacy instead of obesity for Chinese children. BMC Public Health. 2017;17(1):440. doi: 10.1186/s12889-017-4381-x.

Yang Q, Yuan T, Yang L, Zou J, Ji M, Zhang Y, et al. Household food insecurity, dietary diversity, stunting, and anaemia among left-behind children in poor rural areas of China. Int J Environ Res Public Health. 2019;16(23):4778. doi: 10.3390/ijerph16234778.

Li Y, Wedick NM, Lai J, He Y, Hu X, Liu A, et al. Lack of dietary diversity and dyslipidaemia among stunted overweight children: The 2002 China National Nutrition and Health Survey. Public Health Nutr. 2011;14(5):896–903. doi: 10.1017/S1368980010002971.

Sealey-Potts C. An assessment of dietary diversity and nutritional status of preschool children. Austin J Nutri Food Sci. 2014;2(7):5.

dela Luna KL, Bullecer E. Underweight among preschool children as an acute consequence of household food insecurity in Occidental Mindoro. Philippine Journal of Science. 2020;149(3). doi: 10.56899/149.03.19.

Mahmudiono T, Sumarmi S, Rosenkranz RR. Household dietary diversity and child stunting in East Java, Indonesia. Asia Pac J Clin Nutr. 2017;26(2):317–325.

Moughan PJ. Population protein intakes and food sustainability indices: The metrics matter. Global Food Security. 2021;29:100548. doi: 10.1016/j.gfs.2021.100548.

de Castro MBT, Freitas Vilela AA, Oliveira ASD, Cabral M, Souza RAG, Kac G, Sichieri R. Sociodemographic characteristics determine dietary pattern adherence during pregnancy. Public Health Nutr. 2016;19(7):1245–1251. doi: 10.1017/S1368980015002700.

Minaker LM, Mah CL, Cook BE. Population Health Intervention Research. London: Routledge; 2016.