Association between minimum dietary diversity and growth among children aged 6–23 months in Pakistan: a propensity score matching approach

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Minimum dietary diversity (MDD) is an important indicator of complementary feeding quality and has been associated with child nutritional status. This study examines the association between adequate MDD and growth outcomes among children aged 6–23 months in Pakistan using a pooled dataset comprising children from four provinces of Pakistan. This cross-sectional study analyses pooled data for 18,680 children aged 6–23 months from the most recent Multiple Indicator Cluster Surveys (MICS) conducted in the four provinces of Pakistan. Propensity scores are estimated from child, maternal, and household characteristics to improve covariate balance between children with adequate and inadequate MDD. Survey-weighted logistic regression is then conducted before and after kernel matching to examine the associations of adequate MDD with stunting, wasting, and underweight. The prevalence of stunting, wasting, and underweight was 34% (95% CI: 33–35), 13% (95% CI: 12.0–14), and 23% (95% CI: 22–24), respectively. Overall, 18.8% of children achieved adequate MDD, with provincial estimates ranging from 16.5% to 23.5%. Older children aged 18–23 months had higher odds of achieving adequate MDD than those aged 6–11 months (OR = 2.36, 95% CI: 2.11–2.64). Higher maternal education (OR = 1.69, 95% CI: 1.42–2.00) and higher household wealth were also positively associated with adequate MDD. Importantly, through the post-matching analysis, adequate MDD is associated with lower odds of stunting (OR = 0.76, 95% CI: 0.69–0.84), wasting (OR = 0.78, 95% CI: 0.68–0.89), and underweight (OR = 0.76, 95% CI: 0.68–0.85). Comparable findings from survey-weighted regression and post-match analyses indicate robustness across analytical approaches. Adequate minimum dietary diversity is associated with lower odds of stunting, wasting, and underweight among children aged 6–23 months in Pakistan. The similarity of findings across different model specifications strengthens confidence in the documented associations. However, the cross-sectional design and the possibility of residual confounding preclude causal inference. These findings support continued consideration of dietary diversity within child nutrition policies and programs.