# **Appendix.  Data sources – technical annex**

# **<u>Measures of diet characteristics, by age group</u>**

This appendix provides additional detail and sources for the measures required to model the economic impact of unhealthy diets. Tables 1, 2 and 3 provide further detail to Table 2 of the main text, organized according to the same age groups (6-23 months; adolescents; women of reproductive age; adults). For each age group, there are dietary recommendations as to foods to include, and foods to avoid. Tables 4 and 5 provide details on data sources, and Table 6 summarizes the current WHO dietary guidelines.

# **1. Exclusive breastfeeding under six months (EBF) infants < 6 months**

The WHO Global Strategy for Infant and Young Child Feeding recommends that infants be exclusively breastfed until they turn six months of age. Exclusive breastfeeding is the safest and healthiest option for children everywhere, guaranteeing infants a food source that is uniquely adapted to their needs while also being safe, clean, healthy and accessible.

# **2. Infants and young children 6-23 months**

To measure diets of young children, a set of 17 indicators for assessing infant and young child feeding practices were updated and published in 2021 by WHO and UNICEF.<sup>6</sup> The recommended indicators are population-level indicators designed for data collection in large-scale surveys to support program assessment, planning and monitoring. UNICEF currently maintains a global database for these indicators, with the most recent update in October 2022.<sup>7</sup>

# **3. Children 3-5 years, school-age children and adolescents**

There are no global guidelines on older children and adolescent diets. WHO (2018)<sup>8</sup> does have a guideline on promoting physical activity in this age group.

# **4. Women of reproductive age (15-49 years)**

For women of reproductive age, various dietary measures have been developed to assess the level of nutrient adequacy (or risk of micronutrient inadequacy) as well as consumption of foods that are associated with lower or higher risk of overweight, obesity and related NCDs.

**Minimum dietary diversity for women** is an indicator designed and validated as a proxy for one dimension of diet quality (micronutrient adequacy) for non-pregnant women 15-49 years of age. MDD-W is calculated based on reported intake of 10 food groups and is defined as consumption of at least five out of these 10 food groups.

There is currently no harmonized database for MDD-W globally, due in part to varying methods of data collection (open and sentinel list-based recalls, national and subnational surveys). The **Food Systems Dashboard** currently hosts MDD-W meta-data for 55 countries plus Palestine (54 LMIC), based on Gallup World Poll data that are not open-access and were collected using a telephone-based interview. In the future, additional MDD-W data are expected to be available from at least 21 nationally representative DHS surveys.

> 6 Indicators for assessing infant and young child feeding practices: definitions and measurement methods ( World Health Organization and UNICEF 2021).

> 7 UNICEF (2022). https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/

> 8 WHO (2018). Guideline: implementing effective actions for improving adolescent nutrition. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/260297

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