Systematic Review| Volume 54, ISSUE 1, P65-83, January 2022

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Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review

  • Roghayeh Molani Gol
    Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

    Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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  • Sorayya Kheirouri
    Address for correspondence: Sorayya Kheirouri, PhD, Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St, Tabriz, Iran 5166614711
    Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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  • Mohammad Alizadeh
    Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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      This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years.


      This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

      Setting and Participants

      PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: “Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety,” “under-nutrition or stunting or wasting or underweight or nutritional status,” and “children or infants.” Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles.

      Main Outcome Measures, Analysis, and Results

      Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight.

      Conclusions and Implications

      The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.

      Key Words

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