scholarly journals Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3777
Author(s):  
Hlaing Hlaing-Hlaing ◽  
Kristine Pezdirc ◽  
Meredith Tavener ◽  
Erica L. James ◽  
Alexis Hure
Keyword(s):  
New Zealand ◽  
Diet Quality ◽  
Critical Appraisal ◽  
Assessment Method ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Nutritional Epidemiology ◽  
Food Groups ◽  
Quality Indices ◽  
Dietary Guideline

Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.

scholarly journals Defining Diet Quality: A Review of Diet Metrics as Applied to the Double Burden of Malnutrition (OR17-01-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Victoria Miller ◽  
Patrick Webb ◽  
Renata Micha ◽  
Dariush Mozaffarian
Keyword(s):  
Healthy Eating ◽  
Diet Quality ◽  
Fruits And Vegetables ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Healthy Diet ◽  
Food Groups ◽  
Policy Action ◽  
Double Burden ◽  
Meta Analyses

Abstract Objectives Meeting most of the UN Sustainable Development Goals (SGDs) will require a strong focus on tackling all forms of malnutrition─ addressing maternal and child health (MCH) as well as diet-related non-communicable diseases (NCDs). Yet, the optimal metrics to define a healthy diet remain unclear. Our aim was to comprehensively review diet metrics and assess the evidence on each metric's association with MCH and NCDs. Methods Using comprehensive searches and expert discussions, we identified metrics that i) are used in ≥3 countries to link diet to health, ii) quantify the number of foods/food groups consumed and/or iii) quantify recommended nutrient intakes. We reviewed and summarized each metric's development, components and scoring. For each identified metric, we systematically searched PubMed to identify meta-analyses or narrative reviews evaluating these metrics with nutrient adequacy and health outcomes. We assessed validity by grading the number of studies included and the consistency of the diet metric-disease relationship. Results We identified 6 MCH, 13 NCD and 0 MCH/NCD metrics. Most were developed for describing adherence to dietary guidelines or patterns, and others were developed for predicting micronutrient adequacy. On average, the metrics included 14 food groups/nutrients (range 4–45), with 10 food-group only metrics and 0 nutrient-only metrics. The most frequent metric components were grains/roots/tubers, fruits and vegetables. We identified 16 meta-analyses and 14 narrative reviews representing 102 metric-disease relationships (98 metric-NCD and 4 metric-MCH relationships, respectively). We found 5 metrics that have been consistently validated in meta-analyses and narrative reviews for NCDs, 1 metric with limited evidence for MCH, but 0 metrics for both. Of the metrics, the Alternative Healthy Eating Index (aHEI), Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI), and Mediterranean Diet Score (MED) were most commonly validated, especially for all-cause mortality and cardiovascular disease (Figure 1). Conclusions Few diet metrics have been used in multiple countries to define a healthy diet. This suggests a serious gap in global analyses of diet quality relating to malnutrition in all its forms, which hinders effective policy action. Funding Sources Gates Foundation. Supporting Tables, Images and/or Graphs

scholarly journals A comparison of diet quality indices in a nationally representative cross-sectional study of Iranian households

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara Ebrahimi ◽  
Sarah A. McNaughton ◽  
Rebecca M. Leech ◽  
Morteza Abdollahi ◽  
Anahita Houshiarrad ◽  
...  
Keyword(s):  
Diet Quality ◽  
Urban Areas ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
World Health ◽  
Future Research ◽  
Quality Indices ◽  
Cross Sectional ◽  
Nutrient Adequacy ◽  
Household Heads

Abstract Background Iranian diet quality has been evaluated using indices that have not been created based on Iranian dietary guidelines. This study aimed to examine the applicability of two diet quality indices by examining their associations with nutrient adequacy, nutrient intakes and sociodemographics. Methods Dietary data were collected using three 24-h dietary recalls from Iranian households. Nutrient adequacy was assessed using World Health Organization/Food and Agriculture Organization 2002 (WHO/FAO) cut points. Household diet quality was calculated using the Healthy Eating Index (HEI) and Diet Quality Index-International (DQI-I). Sociodemographics of the household members were assessed. Regression analyses were used to examine associations between diet quality and nutrient adequacy, and between sociodemographics and diet quality. Results A total of 6935 households were included in the analysis. Higher household diet quality was associated with adequate intake of calcium (HEI: OR 1.11, 95% CI: 1.10, 1.13; DQI-I: OR 1.14, 95% CI: 1.13, 1.16), vitamin C (HEI: OR 1.19, 95% CI: 1.17, 1.20; DQI-I: OR 1.12, 95% CI: 1.11, 1.12) and protein (HEI: OR 1.01, 95% CI: 1.00, 1.02; DQI-I: OR 1.09, 95% CI: 1.08, 1.09). Higher household diet quality was associated with household heads who were older (> 56 years old) (HEI: β 2.06, 95% CI: 1.63, 2.50; DQI-I β 2.90, 95% CI: 2.34, 3.45), higher educated (college/university completed) (HEI: β 4.54, 95% CI: 4.02, 5.06; DQI-I: β 2.11, 95% CI: 1.45, 2.77) and living in urban areas (HEI: β 2.85, 95% CI: 2.54, 3.16; DQI-I: β 0.72, 95% CI: 0.32, 1.12). Conclusions Based on associations with nutrient adequacy and sociodemographics, the applicability of two diet quality indices for assessing the diet quality of Iranian households was demonstrated. Results also indicated DQI-I may be more applicable than HEI for evaluating Iranian nutrient adequacy. Findings have implications for the design and assessment of diet quality in Iranian populations. Future research should examine the link between these diet quality indices and health outcomes.

scholarly journals Adherence to dietary guidelines and 15-year risk of all-cause mortality

2012 ◽  
Vol 109 (3) ◽  
pp. 547-555 ◽  
Author(s):  
Joanna Russell ◽  
Victoria Flood ◽  
Elena Rochtchina ◽  
Bamini Gopinath ◽  
Margaret Allman-Farinelli ◽  
...  
Keyword(s):  
Diet Quality ◽  
Population Based ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Mortality Data ◽  
Food Groups ◽  
Multiple Data ◽  
All Cause Mortality ◽  
The Relationship ◽  
Reduced Risk

Past investigation of diet in relation to disease or mortality has tended to focus on individual nutrients. However, there has been a recent shift to now focus on overall patterns of food intake. The present study aims to investigate the relationship between diet quality reflecting adherence to dietary guidelines and mortality in a sample of older Australians, and to report on the relationship between core food groups and diet quality. This was a population-based cohort study of persons aged 49 years or older at baseline, living in two postcode areas west of Sydney, Australia. Baseline dietary data were collected during 1992–4, from 2897 people using a 145-item Willett-derived FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine diet quality scores. The Australian National Death Index provided 15-year mortality data using multiple data linkage steps. Hazard risk (HR) ratios and 95 % CI for mortality were assessed for diet quality. Subjects in quintile 5 (highest) of the Total Diet Score had a 21 % reduced risk of all-cause mortality (HR 0·79, 95 % CI 0·63, 0·98, Ptrend= 0·04) compared with those in quintile 1 (lowest) after multivariate adjustment. The present study provides longitudinal support for a reduced risk of all-cause mortality in an older population who have greater compliance with published dietary guidelines.

scholarly journals Diet quality indices for research in low- and middle-income countries: a systematic review

2019 ◽  
Vol 77 (8) ◽  
pp. 515-540 ◽  
Author(s):  
Laura Trijsburg ◽  
Elise F Talsma ◽  
Jeanne H M de Vries ◽  
Gina Kennedy ◽  
Anneleen Kuijsten ◽  
...  
Keyword(s):  
Diet Quality ◽  
Food System ◽  
Data Extraction ◽  
High Income ◽  
Dietary Guidelines ◽  
Food Groups ◽  
Quality Indices ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Context Dietary intake research has increasingly focused on improving diet quality in low- and middle-income countries (LMICs). Accompanying this is the need for sound metrics to assess diet quality. Objective This systematic literature review aims to describe existing diet quality indices for general populations and highlights recommendations for developing such indices for food system research in LMICs. Data sources Three electronic databases were searched for papers published between January 2008 and December 2017. Data extraction Articles published in English and describing the development of an index to measure overall diet quality, irrespective of whether they were for high-income countries or LMICs, were included. Data analysis Eighty-one indices were identified, over two thirds were based on national dietary guidelines from high-income countries. Of the 3 key diet quality dimensions, “diversity” was included in all 18 indices developed for LMICs, “moderation” was captured by most, and “nutrient adequacy” was included 4 times. Conclusions Indices need to be developed that include all dimensions, include foods and/or food groups rather than nutrients, use an optimal range for individual components in the score, and express the intake of healthy and unhealthy components separately. Importantly, validation of the index should be part of its development.

Abstract P360: Dietary Saturated Fats From Different Food Sources Show Inconsistent Associations With Various Indices of Diet Quality in the Canadian Population

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Stephanie Harrison ◽  
Didier Brassard ◽  
Simone Lemieux ◽  
Benoit Lamarche
Keyword(s):  
Healthy Eating ◽  
Diet Quality ◽  
Nutritive Value ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Food Sources ◽  
Dietary Intakes ◽  
Trans Fat ◽  
Quality Indices ◽  
Saturated Fats

Background: Canadian dietary guidelines include a recommendation to limit the consumption of foods high in saturated fats (SFA), regardless of their dietary source. The same guidelines also recommend consumption of lean red meat and low-fat dairy products. Yet, the association between the consumption of SFA from different food sources and diet quality is currently unknown. The objective of this study was to examine associations between SFA from various food sources and different indices of diet quality. Methods: Analyses are based on a sample of 11 106 respondents representative of Canadian adults (19-70 y) from the 2015 Canadian Community Health Survey (CCHS 2015). Dietary intakes and diet quality indices were calculated using a single interview-administered 24-hour recall. Food sources of SFA were classified according to the 2019 Canada’s Food Guide categories: 1) vegetables and whole fruits, 2) whole grain foods and 3) protein foods (including dairy and meat, among others). Foods not included in these three categories were grouped as All other foods . The 2010 alternative Healthy eating index (aHEI), the 2015 Healthy eating index (HEI-2015) and the 2007 Canadian Healthy eating index (C-HEI) were calculated. Due to the unreliability of data for trans-fat consumption in the CCHS 2015 database, the trans-fat subscore of the aHEI was removed from the original score. Results: While total SFA intake and SFA from All other foods were inversely correlated with all indices of diet quality (-0.55<r<-0.10, all p<0.001), associations with SFA from dairy and meat were inconsistent. SFA from dairy were inversely correlated (p<0.001) with the aHEI (r=-0.14) and the HEI-2015 (r=-0.16) but showed a weak positive correlation with the C-HEI (r=0.05, p<0.001). SFA from meat were negatively correlated with the aHEI (r=-0.21, p<0.001) and positively correlated with the C-HEI (r=0.11, p<0.001). Removing subscores directly related to SFA intake in diet quality indices yielded positive correlations between SFA from dairy and the HEI-2015 (r=0.13, p<0.001) and the C-HEI (r=0.19, p<0.001). Conclusion: Consumption of SFA from different food sources are inconsistently associated with different indices of overall diet quality. Unsurprisingly, SFA from All other foods , which include low nutritive value foods, showed the strongest negative correlation with all diet quality scores. These results provide further support to the notion that guidance on SFA in future health policies should focus on food sources rather than on total intake of SFA.

Abstract P355: Development and Validation of a Nutrient Density Score That Includes Foods Groups

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jessica D Smith ◽  
Victor Fulgoni ◽  
Adam Drewnowski
Keyword(s):  
Diet Quality ◽  
Saturated Fat ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Food Groups ◽  
Unsaturated Fat ◽  
Nutrient Density ◽  
Density Score ◽  
Considerable Work ◽  
Development And Validation

Introduction: There has been considerable work performed on nutrient profiling to assess the nutritional contribution of a food to a healthy dietary pattern. Most profiling approaches have focused on nutrients to limit and nutrients to encourage. A few profiling approaches have also included certain food groups in the profiling algorithm. Objectives: The objective of this study was to develop a nutrient density score, based on the Nutrient Rich Food Index (NRF) 6.3, that includes food groups and validate the score against a gold-standard marker of diet quality, the Healthy Eating Index (HEI) 2015. Methods: Stepwise regression was used to develop a nutrient density score based on the day 1 total dietary intake of the U.S. population 2 years and older (excluding pregnant and lactating women) from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 (n=23,743). Intake of food groups was taken from the Food Patterns Equivalent Database (FPED) 2011-2016. Sixteen nutrients (as a percent of the Daily Value) as well as five food groups (as a percentage of recommended intake in 2015-2020 Dietary Guidelines) were considered in the score. Results: When only the 16 nutrients were included in the score, 66% of the variability in the HEI 2015 could be accounted for (R 2 = 0.66). When only the five food groups were considered, the maximum R 2 with the HEI 2015 was 0.50. However, when both nutrients and foods groups were considered, the model explained 74% of the variability in the HEI 2015 (Table). The increase in the R 2 begins to plateau after the inclusion of 10 elements: 3 nutrients to encourage (fiber, potassium and unsaturated fat), 4 food groups (dairy, fruit, whole grains, and nuts and seeds) and 3 nutrients to limit (added sugar, saturated fat, sodium). Conclusion: A nutrient density score that includes both nutrients and foods groups best predicts diet quality as measured by the HEI 2015.

scholarly journals Associations of Maternal Sociodemographic Characteristics and Eating Behaviors with Infant Feeding Behaviors

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1046-1046
Author(s):  
Tonja Nansel ◽  
Leah Lipsky ◽  
Carolina Schwedhelm ◽  
Breanne Wright ◽  
Chelsie Temmen ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Diet Quality ◽  
Maternal Education ◽  
Healthy Eating Index ◽  
Fruit And Vegetables ◽  
Infant Food ◽  
Food Groups ◽  
Feeding Behaviors ◽  
White Race ◽  
Maternal Characteristics

Abstract Objectives This study examines associations of maternal characteristics with infant feeding of discretionary and health-promoting foods. Methods Mothers in PEAS, a prospective cohort study, reported maternal and child dietary intake, demographics, and eating competence (EC). Maternal diet quality (Healthy Eating Index-2015, HEI) was calculated combining 24-hour diet recalls at 6 weeks, 6, and 12 months postpartum (n = 209). Infant food frequency questionnaires were completed at 6, 9, and 12 months, assessing age of introduction and intake frequency of food groups. T-tests examined bivariate associations of demographics with feeding of discretionary sweets, discretionary savory foods, fruit, and vegetables. Linear regressions examined associations of maternal EC and HEI with infant feeding controlling for demographics. Results Fruit, vegetables, discretionary sweet, and discretionary savory foods were introduced at 5.8 ± 1.7, 5.9 ± 1.7, 8.0 ± 2.0, and 8.8 ± 1.8 months, respectively. Earlier introduction of fruit and vegetables was associated with higher maternal education, white race, and nulliparity; earlier introduction of vegetables was also associated with higher income. Age of introduction of discretionary sweet and savory foods was not associated with maternal demographics, HEI, or EC. At age 12 months, greater infant intake frequency of fruit and vegetables was associated with higher education and income, white race, and breastfeeding, while greater intake frequency of discretionary sweet and savory foods was associated with lower maternal education and minority race. Greater intake frequency of sweets was also associated with multiparity and greater intake frequency of discretionary savory foods was associated with lower income. Maternal HEI was positively associated with infant intake frequency of fruit, vegetables, and discretionary sweet and savory foods. Maternal EC was positively associated with infant intake frequency of fruit and vegetables. Conclusions Demographic differences in infant feeding behaviors indicates these behaviors as critical intervention targets to address disparities in child diet quality. Associations of maternal HEI and EC with infant feeding behaviors suggest potential pathways of maternal influence on infant diet. Funding Sources This research was supported by the NICHD Intramural Research Program.

scholarly journals Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality in Adults in the National Health and Nutrition Examination Survey 2015–2016

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2952
Author(s):  
Yong Zhu ◽  
Neha Jain ◽  
Vipra Vanage ◽  
Norton Holschuh ◽  
Anne Hermetet Agler ◽  
...  
Keyword(s):  
United States ◽  
Dietary Intake ◽  
National Health ◽  
Diet Quality ◽  
The United States ◽  
Healthy Eating Index ◽  
Nutrition Examination Survey ◽  
Food Groups ◽  
Dietary Recall ◽  
Health And Nutrition

This study examined differences in dietary intake between ready-to-eat cereal eaters and non-eaters in adults from the United States. Participants (n = 5163) from the National Health and Nutrition Examination Survey 2015–2016 were included. One-day dietary recall was used to define ready-to-eat cereal consumption status and estimate dietary intake in eaters and non-eaters. Data from Food Patterns Equivalent Database 2015–2016 were used to compare intakes of food groups by consumption status. Diet quality was assessed by Healthy Eating Index 2015. Nineteen percent of US adults were ready-to-eat cereal eaters; they had a similar level of energy intake as non-eaters, but they had significantly higher intake of dietary fiber, and several vitamins and minerals, such as calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, and vitamin D. They were also more likely to meet nutrient recommendations. Compared to non-eaters, ready-to-eat cereal eaters had the same level of added sugar intake but they had significantly higher intake of whole grains, total fruits, and dairy products. The diet quality of ready-to-eat cereal eaters was significantly higher than that of non-eaters. The study supports that ready-to-eat cereal eaters have better dietary intake with a healthier dietary pattern than non-eaters in the United States.

scholarly journals Dietary intake and diet quality by weight category among a racially diverse sample of women in Birmingham, Alabama, USA

2020 ◽  
Vol 9 ◽  
Author(s):  
Rebecca B. Little ◽  
Renee Desmond ◽  
Tiffany L. Carson
Keyword(s):  
Diet Quality ◽  
Weight Status ◽  
Vegetable Intake ◽  
The United States ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Rank Test ◽  
Deep South ◽  
Weight Category ◽  
Maximum Score

Abstract Diet is a modifiable contributor to health. The lack of adherence to recommended dietary guidelines may contribute to the disproportionate burden of obesity and other chronic conditions observed in the Deep South region of the United States. The objective of this cross-sectional study was to describe food group intake and diet quality by race and weight status of women in the Deep South. Study participants were eighty-nine healthy female volunteers (56 % black, 44 % white, mean age 39⋅7 ± 1⋅4 years) recruited from Birmingham, AL, USA. Body Mass Index (BMI) determined weight status (non-obese/obese). Healthy Eating Index-2010 (HEI-2010) calculated from dietary recalls assessed diet quality. Wilcoxon sum-rank test compared HEI-2010 scores by race and weight status. χ2 analysis compared the percentage of women who achieved maximum points for HEI-2010 index food components by subgroup. Caloric and macronutrient intake did not differ by race or weight status (mean kcal 1863⋅0 ± 62⋅0). Median Total HEI-2010 Score for the sample was 51⋅9 (IQR: 39⋅1–63⋅4). Although there was no statistical difference in diet quality by race, more whites achieved the maximum score for vegetable intake compared to blacks, while blacks reported higher total fruit intake. Non-obese women reported better diet quality (56⋅9 v. 46⋅1; P = 0⋅04) and eating more whole fruits, and more achieved the maximum score for protein from plant and seafood sources. In summary, differences in diet quality were observed by weight status, but not race among this sample. These results point to tailored dietary interventions for women in metropolitan areas of Alabama, USA.

Abstract P108: Metabolic Profile Of Diet Quality In The Multi-Ethnic Study Of Atherosclerosis

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Meghana Gadgil ◽  
Alexis F Wood ◽  
Ibrahim Karaman ◽  
Goncalo Gomes Da Graca ◽  
Ioanna Tzoulaki ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Diet Quality ◽  
Spectral Feature ◽  
Healthy Eating Index ◽  
Dietary Guidelines ◽  
Elastic Net ◽  
Dietary Quality ◽  
Spectral Features ◽  
Ethnic Study ◽  
Diet Score

Introduction: Poor dietary quality is a well-known risk factor for diabetes and cardiovascular disease (CVD), however metabolites marking adherence to U.S. dietary guidelines are unknown. Our goal was to determine a pattern of metabolites associated with the Healthy Eating Index-2015 (HEI-2015). We hypothesize that there will be metabolites positively and negatively associated with the HEI-2015 score, including those previously linked to diabetes and CVD. Methods: Sample: 2269 adult men and women from the Multi-Ethnic Study of Atherosclerosis (MESA) longitudinal cohort study without known cardiovascular disease or diabetes. Data/specimens: Fasting serum specimens, diet and demographic questionnaires at baseline. Metabolomics: Untargeted 1 H NMR CPMG spectroscopy (600 MHz) annotated by internal and external reference data sets. Statistical analysis: Metabolome-wide association study (MWAS) using linear regression models specifying each spectral feature as the outcome in separate models, HEI-2015 score as the predictor, and adjustment for age, sex, race, and study site, accounting for multiple comparisons. Elastic net regularized regression was used to select an optimal subset of features associated with HEI-2015 score. Separately, hierarchical clustering defined discrete groups of correlated NMR features also tested for association with HEI-2015 score. Results: MWAS identified 1914 spectral features significantly associated with the HEI-2015 diet score. After elastic net regression, 35 metabolomic spectral features remained associated with HEI-2015 diet score. Cluster analysis identified seven clusters, three of which were significantly associated with HEI-2015 score after Bonferroni correction. (Table) Conclusions: Cholesterol moieties, proline betaine, proline/glutamate and fatty acyls chains were significantly associated with higher diet quality in the MESA cohort. Further analysis may clarify the link between dietary quality, metabolites, and pathogenesis of diabetes and CVD.

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