Biodiversity is key for human and environmental health. Available dietary and ecological indicators are not designed to assess the intricate relationship between food biodiversity and diet quality. We applied biodiversity indicators to dietary intake data from and assessed associations with diet quality of women and young children. Data from 24-hour diet recalls (55% in the wet season) of n = 6,226 participants (34% women) in rural areas from seven low- and middle-income countries were analyzed. Mean adequacies of vitamin A, vitamin C, folate, calcium, iron, and zinc and diet diversity score (DDS) were used to assess diet quality. Associations of biodiversity indicators with nutrient adequacy were quantified using multilevel models, receiver operating characteristic curves, and test sensitivity and specificity. A total of 234 different species were consumed, of which <30% were consumed in more than one country. Nine species were consumed in all countries and provided, on average, 61% of total energy intake and a significant contribution of micronutrients in the wet season. Compared with Simpson's index of diversity and functional diversity, species richness (SR) showed stronger associations and better diagnostic properties with micronutrient adequacy. For every additional species consumed, dietary nutrient adequacy increased by 0.03 (P < 0.001). Diets with higher nutrient adequacy were mostly obtained when both SR and DDS were maximal. Adding SR to the minimum cutoff for minimum diet diversity improved the ability to detect diets with higher micronutrient adequacy in women but not in children. Dietary SR is recommended as the most appropriate measure of food biodiversity in diets.

Department of Agricultural Biology Faculty of Agriculture University of Ruhuna 81100 Matara Sri Lanka

Department of Crop Sciences and Agroforestry Faculty of Tropical AgriSciences Czech University of Life Sciences Prague 165 21 Prague 6 Suchdol Czech Republic

Department of Food Safety and Food Quality Faculty of Bioscience Engineering Ghent University 9000 Ghent Belgium

Department of Food Safety and Food Quality Faculty of Bioscience Engineering Ghent University 9000 Ghent Belgium;

HealthBridge Foundation of Canada 10000 Hanoi Vietnam

Healthy Diets from Sustainable Food Systems Initiative Bioversity International 00057 Maccarese Italy

KERMIT Department of Mathematical Modeling Statistics and Bioinformatics Faculty of Bioscience Engineering Ghent University 9000 Ghent Belgium

Laboratory of Tropical and Subtropical Agronomy and Ethnobotany Faculty of Bioscience Engineering Ghent University 9000 Ghent Belgium

Rural Research Center Faculty of Life Sciences Nutrition Escuela Superior Politecnica del Litoral Guayaquil 090608 Ecuador

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