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Alive and Thrive, Nutrition, Diets, and Health (NDH); Poverty, Gender, and Inclusion (PGI), Background The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements. Objective This study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15–49 y in LMICs. Methods We used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60. Results In the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%). Conclusions The WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15–49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.

Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Background: Preterm and small for gestational age (SGA) remain significant public health concerns worldwide. Yet limited evidence exists on their growth patterns during childhood from low-or middle-income countries. Objectives: We investigated the postnatal growth patterns of preterm and SGA compared to term appropriate for gestational age (AGA) children from birth to 10–11y, and examined the impact of birth status on child nutritional status during the school age years. Methods: Children born to women who participated in a double-blinded randomized controlled trial of preconception micronutrient supplementation in Vietnam were classified into three groups: preterm AGA (n = 130), full-term SGA (n = 165) and full-term AGA (n = 1,072). Anthropometric data (weight and height) were collected prospectively at birth, 3, 6, 12, 18, 24 months and at 6–7 and 10–11y. We used ANOVA and multiple regression models to examine the differences in growth patterns from birth to 10–11y as well as child undernutrition and overnutrition by birth status. Results: Children who were born preterm exhibited rapid postnatal growth, but still had lower HAZ at 1y and 2y and showed catch up to the AGA group at 6y. Compared to those born AGA, SGA infants had higher risk of thinness (BMIZ < −2) at 2y and 6y (adjusted Odds Ratio, AOR [95% CI] 2.5 [1.0, 6.1] and 2.6 [1.4, 4.6], respectively); this risk reduced at 10–11y (1.6 [0.9, 2.8]). The risk of stunting (HAZ < −2) was also 2.4 [1.5, 3.8] and 2.3 times [1.2, 4.1] higher in SGA than AGA group at ages 2y and 6–7y, respectively, with no differences at 10y. Although preterm children had higher rates of thinness and stunting at 2y compared to AGA children, these differences were not statistically significant. No associations were found between preterm or SGA and overweight /obesity at age 10–11y. Conclusion: Children who were born term-SGA continued to demonstrate deficits in weight and height during childhood whereas those born preterm showed catch

Non-PR, IFPRI1; DCA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Diet-related risks cause 20% of global deaths (~11 million) per year (Afshin et al., 2019). Increased urbanization in low- and middle-income countries accompanied by a nutrition transition, involving increased consumption of unhealthy, processed foods and reductions in physical activity, has exacerbated diet-related risks, leading to increases in rates of overweight and obesity (Popkin et al., 2020). Diets in urban settings are also affected by the reduced time for food preparation, convenience and affordability of unhealthy foods. We developed an artificial-intelligence-based phone application called Food Recognition Assistance and Nudging Insights (FRANI) to tackle these problems. FRANI was previously validated against observed weighed records, the gold standard for diet assessment, and shown to be as accurate as a trained dietician undertaking a standard, multi-pass 24-hr recall (Folson et al., 2023). FRANI was developed to also provide gamified nudges and personalized feedback designed to promote healthy food choices. The objectives of this study were to measure the acceptability, adherence, and likeability of FRANI, as well as its effects on the food choices of female youth in Accra, Ghana.

PR, IFPRI3; DCA; 2 Promoting Healthy Diets and Nutrition for all; ISI, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Unhealthy eating habits are common among adolescents in Vietnam, where transitioning food environments increasingly offer energy-dense micronutrient-poor foods. Successful behavior change approaches must be feasible and acceptable, promoting local foods that are available, accessible, and preferred. Yet, few studies have investigated the potential of food-based approaches for adolescents. We used linear programming to identify problem nutrients, local nutrient sources, and realistic food-based recommendations (FBRs) to improve nutrient intake among girls 16–22 years in Thai Nguyen, Vietnam. We then identified a reduced set of FBRs to prioritize the most critical micronutrient gaps. Calcium and iron targets could not be met in any realistic diet modeling scenario. The best set of FBRs included seven recommendations which could meet intake targets for 9 of 11 modeled micronutrients. The best reduced set of three FBRs targeting iron and calcium only—although more feasible for behavior change—was less effective at improving intake of these nutrients since fewer foods were recommended. Given the difficulty of meeting calcium and iron targets using local foods within acceptable dietary patterns, additional interventions, such as supplementation, staple food fortification, or increasing the availability of affordable calcium- and iron-rich foods, may be necessary to promote dietary adequacy for adolescent girls.

PR, IFPRI3; ISI; DCA; CRP4; Alive and Thrive; 2 Promoting Healthy Diets and Nutrition for all; IFPRIOA, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background: Bangladesh is urbanizing rapidly, facing challenges of malnutrition, low coverage and poor quality of urban nutrition services. Objectives: We assessed the impact of integrating maternal, infant, and young child nutrition interventions, delivered at urban Maternal Neonatal and Child Health facilities, on maternal dietary diversity, iron-folic acid (IFA) and calcium consumption, and child feeding practices. Methods: We used a quasi-experimental design with a non-random assignment of 20 health facilities in Dhaka to intensive and standard service arms. We conducted facility-based observations and community-based surveys at baseline (2020) and endline (2022) (n=2,455 observations and surveys with 1,678 pregnant [PW] or recently delivered women [RDW] at endline). We derived difference-in-difference (DID) estimates, adjusted for characteristics that differed at baseline or endline, and accounted for clustering. Results: Exposure to antenatal care (ANC) was similar in both arms: two-thirds of RDW received ANC during the first trimester and three-fourths received ≥4 ANC check-ups. Compared to the standard arm, a higher proportion of PW in the intensive arm received counselling on dietary diversity (DID: 45 percentage points [pp]), and a higher proportion of RDW received IFA (25pp) and calcium supplementation (19pp), adequate weight gain (44pp), and appropriate child feeding (27pp). Improvements were greater in the intensive than standard arm for number of food groups consumed (DID: 1.1 food groups) and minimum dietary diversity (23pp); no impact was observed for IFA and calcium consumption during pregnancy. Impacts were observed for early initiation (20pp), exclusive breastfeeding (45pp), introduction of solid or semi-solid foods (28pp), and egg and/or flesh food consumption (33pp) among children. Minimum dietary diversity and acceptable diet remained low in both arms. Conclusions: Intensifying nutrition in government-aligned health services delivered by experi

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy

PR, IFPRI3; ISI; CRP4; Capacity Strengthening; DCA; 2 Promoting Healthy Diets and Nutrition for all; Nudging for Good, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Background Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs. Objective We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12–18 y (n = 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR). Methods Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC). Results Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively). Conclusions FRANI AI–assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors an

Non-PR, IFPRI1; POSHAN; 2 Promoting Healthy Diets and Nutrition for all; CRP4, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy; SAR; A4NH, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), Early life nutrition sets the stage for the health, nutrition, and development of young children. Optimal infant and young child feeding (IYCF) practices begin with timely initiation of breastfeeding, followed by exclusive breastfeeding and complementary feeding. This Data Note provides an overview of trends and patterns in IYCF practices in India at the national-, state-, and district levels based on the 2015-16 and 2019-21 National Family Health Surveys (NFHS) data. IYCF indicators were created following World Health Organization and UNICEF’s 2021 guidelines.

Non-PR, 2 Promoting Healthy Diets and Nutrition for all; IFPRI1; POSHAN, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, South Asia is home to more adolescents than any global region, and one in five adolescents globally live in India. Among the many issues that adolescents face, poor nutrition, non-communicable diseases (NCDs), marriage, and childbearing are of key importance as they have far-ranging and intergenerational consequences. This Data Note examines the national-level trends and spatial variability at state and district levels for a set of key nutrition outcomes, NCDs, marriage, and childbearing status among Indian adolescents (15-19 years; girls and boys). The findings are based on data from the three rounds of India’s National Family Health Surveys (NFHS) – NFHS 2006, 2016, and 2021. The Data Note concludes with key takeaways for adolescents’ wellbeing and identifies areas for improvement. This Data Note can be used for further inquiry by stakeholders including researchers, policymakers, and program staff at multiple levels.

PR, IFPRI3; ISI; DCA; Capacity Strengthening; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Adolescence is a sensitive transition time that affects rights, roles, and responsibilities in food choice, yet limited evidence exists on dietary intakes during this critical period. This study assessed the food consumption pattern and the adequacy of energy, macronutrient, and micronutrient intakes among female youth belonging to three occupational groups in Vietnam. Dietary intakes were measured for 1001 participants aged 16–22 years using INDDEX24's 24-h recall method. Multivariate regression analyses were conducted to examine differences in diet outcomes among the three occupational groups. Dietary diversity was similar across groups but workers, compared to high school and college students, consumed less baked/grain-based sweets and fast foods, and more soft drinks, other sweets, and processed meat. Two-thirds of the sample showed energy intake lower than the estimated energy requirement, while a substantial percentage had insufficient or excessive intake of carbohydrate and fat. The mean probability of adequacy of nutrient intakes was low (0.33) and not different across all three occupational groups except for folate, which favored workers. Our study provides novel evidence supporting the development and implementation of interventions to achieve national targets, with emphasis on female youths who undergo special transitions in education, occupation, and lifestyle.

PR, IFPRI3; ISI; DCA; 2 Promoting Healthy Diets and Nutrition for all, Nutrition, Diets, and Health (NDH); Food and Nutrition Policy, Adolescent and young women face grave nutrition challenges, but limited evidence exists on solutions to improve their diets. Action-research was done over 3 years (2020–2022) in secondary cities of Colombia (Medellin) and Vietnam (Thai Nguyen) to identify nutrient deficits in adolescent and young women diets; elaborate food-based recommendations to improve their nutritional status using Optifood linear programming; and engage respondents in incorporating suggested recommendations to their diet using a Social Innovation Challenge approach. A total of 1001 respondents were interviewed in Vietnam, 793 in Colombia. The probability of nutrient inadequacy in both locations was highest for iron and calcium, followed by the risk of deficiency for several other vitamins and minerals. Social Innovation Challenge teams (11 in Vietnam, 9 in Colombia) were created and supported in developing solutions to improve diets and tackle those deficiencies. Awards and resources were transferred to the most promising solutions to enable their implementation. Pre/post measurements of the interventions’ impact using the Global Diet Quality Score as outcome metric showed significant improvement in the diets of Challenge participants. After introducing a series of companion articles that offer detailed results on those various steps, this paper draws strategic lessons from an action-research perspective.