Nutrient density but not cost of the diet is associated with anemia and iron deficiency in school-age children in South Africa

Abstract Objective : The study aimed to investigate the relationship of nutrient density and cost of diets with anemia and iron deficiency (ID) in children. Methods : Dietary intake data of 5- to 12-year-old children (n = 578) from three independent studies in low-income communities were pooled. Nutrient densities were calculated using the Nutrient Rich Foods Index (NRF9.3) and Nutrient Rich Diet Index (NRD9.3), with higher scores indicating more nutrient-dense foods/diets. Food prices and food intake data were used to calculate nutrient density-to-price ratios of foods and diets. Descriptive and correlation analyses examined associations of nutrient density and diet cost with anemia and ID. Results : Most children (>50%) consumed starchy staples (100%), vegetables other than vitamin A-rich (63.9%) and legumes (58.1%), with mean NRF9.3 scores ranging from 31.9 to 56.3. Cheese, eggs, organ meat, fish, dark-green leafy vegetables, and vitamin A-rich vegetables and fruits had mean NRF9.3 scores ranging from 112.6 to 184.7, but each were consumed by less than a third of the children. Children with anemia and with ID had lower NRD9.3 than children without anemia and without ID (P Conclusion : Careful selection of nutrient-dense foods as substitution for foods with lower nutrient-densities could make it possible to consume a diet richer in specific nutrients and help to prevent anemia and ID in children without affecting diet cost.