Agreement of the Modified Mediterranean Prime Screen with a Reference Food Frequency Questionnaire in Assessing Diet Diversity and Micronutrients’ Adequacy Among Women of Reproductive Age in Lebanon [2019-2021]

Abstract

Background: Women of reproductive age (WRA) have elevated nutritional requirements due to their reproductive physiology, pregnancy, and lactation. Adequate dietary intake and micronutrient adequacy are essential for maternal health, optimal pregnancy outcomes, and child growth and development. In Lebanon, WRA face compounded risks of malnutrition due to economic instability, limited food diversity, and restricted access to nutritious foods. The Minimum Dietary Diversity for Women (MDD-W) is a validated measure of diet quality and micronutrient adequacy, yet data on dietary patterns and nutritional status among Lebanese WRA remain scarce, particularly in the context of the ongoing economic crisis.

Objectives: This study aimed to: 1) assess the reproducibility and agreement of the Modified Mediterranean Prime Screen (MMPS) with a reference Food Frequency Questionnaire (FFQ) in evaluating MDD-W and key micronutrient intake; 2) determine micronutrient adequacy among WRA using Estimated Average Requirements (EARs); 3) explore dietary changes and shifts in MDD-W scores during the economic crisis (December 2019–September 2021); and 4) investigate associations between micronutrient adequacy, maternal body mass index (BMI), and neonatal anthropometric outcomes.

Methods: This secondary analysis utilized data from a prospective cohort study conducted between December 2019 and September 2021. Dietary intake was assessed using both a validated FFQ and MMPS, administered over two visits via face-to-face and telephone interviews. MDD-W scores were derived from ten food groups, and nutrient adequacy was calculated for 12 micronutrients (including vitamin D). Agreement between MMPS and FFQ was evaluated using weighted Kappa and intraclass correlation coefficients (ICCs), while nutrient intake correlations were assessed via Pearson coefficients. Nutrient adequacy ratios (NAR) and mean adequacy ratios (MAR) were computed, with EAR-based cutoffs applied. Exploratory analyses examined dietary changes over time and associations between maternal nutritional status and neonatal growth percentiles.

Expected Outcomes: The study will provide a comprehensive overview of dietary diversity, micronutrient intake, and the impact of economic disruptions on WRA in Lebanon. Findings will inform the validity of the MMPS as a practical dietary assessment tool, identify populations at nutritional risk, and guide interventions to improve diet quality and maternal and child health outcomes.