Minimum Acceptable Diet (MAD)

What: The indicator assesses the acceptability of a child's diet based on its micronutrient adequacy and meal frequency and takes breastfeeding into account. This indicator combines information on minimum dietary diversity and minimum meal frequency, with the extra requirement that non-breastfed children should have received milk at least twice on the previous day and night. The minimum acceptable diet is defined as: • for breastfed children: consumed meals consisting of at least 4 food groups used by the Minimum Dietary Diversity (MDD) indicator during the previous day and night; and met the Minimum Meal Frequency for breastfed children. • for non-breastfed children: consumed meals consisting of at least 4 food groups used by the Minimum Dietary Diversity indicator during the previous day and night; met the Minimum Meal Frequency for non-breastfed children; and consumed at least 2 milk feedings (includes infant formula/milk/yogurt) during the previous day and night. Why: WHO guiding principles recommend that children aged 6–23 months be fed meals at an appropriate frequency and in a sufficient variety to ensure, respectively, that energy and nutrient needs are met.

When:

The MAD, along with the other seven IYCF indicators, was developed for assessment at the population level in order to make comparisons across and within countries, to describe trends over time, to target/identify populations at risk, target interventions, make policy decisions about resource allocation, and serve as an impact measure outcome when monitoring and evaluating IYCF programs. Because the MAD indicator captures multiple dimensions of nutrition interventions feeding, it can be used for comparisons across populations with different rates of continued breastfeeding or be presented by breastfed and non-breastfed children.

The calculation of this indicator is different for breastfed and non-breastfed children (see WHO/UNICEF Guidance 2021):

Breastfed children: A breastfed child is considered to have a Minimum Acceptable Diet if the child:

1) Met the Minimum Meal Frequency for breastfed children.

2) During the previous day and night consumed meals consisting of at least 4 food groups used by the Minimum Dietary Diversity (MDD) indicator; however, not counting the food group "breast milk".

Non-breastfed children: A non-breastfed child is considered to have a Minimum Acceptable Diet if the child:

1) Met the Minimum Meal Frequency for non-breastfed children.

2) During the previous day and night consumed meals consisting of at least 4 food groups used by the Minimum Dietary Diversity (MDD) indicator; however, not counting the food group "dairy products" (see comment below).

3) During the previous day and night consumed at least 2 milk feedings (this includes infant formula / milk / yogurt).

To calculate the indicator's value:

- add up the number of 1) breastfed and 2) non-breastfed children who received a Minimum Acceptable Diet

- divide this number by the total number of surveyed breastfed and non-breastfed children

- multiply the result by 100 to convert it to a percentage

Disaggregate the data by gender, age groups, and wealth.

1) Milk feeds are considered a separate and required element for non-breastfed children in this indicator, that is why they are included as an essential part of Minimum Acceptable Diet for non-breastfed children. Exclusion of food group "dairy products" avoids double-counting of this food group.

2) If the caregiver is taking care of two children aged 6 - 23 months (from the same household) and household sampling has been used, then data should be collected for both children. If a list method has been used and children have been identified as the primary sampling unit, then data should only be collected for the sampled child.

3) For further guidance (including the recommended survey questions), please read section "7. Minimum acceptable diet" in UNICEF/WHO 2021  guidance. Be aware that the guidance on Minimum Dietary Diversity (MDD) was changed in 2017 (breast milk was included as eight food group.

4) MAD is one of ECHO's Key Outcome Indicators (see below).