Assessing dietary diversity using the MDD-W indicator in primary healthcare users in southern Brazil

Abstract

Introduction: Dietary diversity is a key indicator of diet quality and micronutrient adequacy, yet evidence among Brazilian Unified Health System (SUS) users remains limited. 

Methods: This cross-sectional study assessed dietary diversity using the Minimum Dietary Diversity for Women (MDD-W) indicator in 166 adults registered in Primary Health Care units across three municipalities in Rio Grande do Sul, Southern Brazil. Dietary diversity was determined based on three non-consecutive 24-hour food intake diaries, with consumption of ≥5 of 10 food groups classified as achieving minimum dietary diversity. 

Results: Sociodemographic, nutritional, and behavioral variables were examined. The median MDD-W score was 5.3 (P25–P75: 4.3–6.3), and 66.9% of the participants achieved minimum dietary diversity. Higher dietary diversity was significantly associated with older age (p=0.001), higher per capita income (p=0.028), occupational stability (p=0.033) and nutritional counseling (p=0.004). Overall consumption patterns were predominated by grains, meat, and dairy, while fruits, vegetables, and nuts were underrepresented. Achieving minimum dietary diversity was significantly driven by the consumption of nutrient-dense groups: nuts and seeds (p=0.001), eggs (p=0.004), dark-green leafy vegetables (p<0.001), vitamin A–rich fruits and vegetables (p<0.001), other fruits (p<0.001) and other vegetables (p<0.001).

Conclusions: The findings highlight that dietary diversity is influenced by socioeconomic inequalities and behavioral factors. These results emphasize the need for policies that expand equitable access to diverse and nutrient-dense foods, together with strengthening continuous and context-specific nutrition education strategies within Primary Health Care.