Search

Abstract Objective: To assess the prospective association of two diet quality scores based on the Nova food classification with BMI gain. Design: The NutriNet-Brasil cohort is an ongoing web-based prospective study with continuous recruitment of participants aged ≥ 18 years since January 2020. A short 24-h dietary recall screener including ‘yes/no’ questions about the consumption of whole plant foods (WPF) and ultra-processed foods (UPF) was completed by participants at baseline. The Nova-WPF and the Nova-UPF scores were computed by adding up positive responses regarding the consumption of thirty-three varieties of WPF and twenty-three varieties of UPF, respectively. Participants reported their height at baseline and their weight at both baseline and after approximately 15 months of follow-up. A 15-month BMI (kg/m2) increase of ≥5 % was coded as BMI gain. Setting: Brazil. Participants: 9551 participants from the NutriNet-Brasil cohort. Results: Increasing quintiles of the Nova-UPF score were linearly associated with higher risk of BMI gain (relative risk Q5/Q1 = 1·34; 95 % CI 1·15, 1·56), whereas increasing quintiles of the Nova-WPF score were linearly associated with lower risk (relative risk Q5/Q1 = 0·80; 95 % CI 0·69, 0·94). We identified a moderate inverse correlation between the two scores (–0·33) and a partial mediating effect of the alternative score: 15 % for the total effect of the Nova-UPF score and 25 % for the total effect of the Nova-WPF score. Conclusions: The Nova-UPF and Nova-WPF scores are independently associated with mid-term BMI gain further justifying their use in diet quality monitoring systems.

Objective: To assess the prospective association of two diet quality scores based on the Nova food classification with BMI gain. Design: The NutriNet-Brasil cohort is an ongoing web-based prospective study with continuous recruitment of participants aged ≥ 18 years since January 2020. A short 24-h dietary recall screener including 'yes/no' questions about the consumption of whole plant foods (WPF) and ultra-processed foods (UPF) was completed by participants at baseline. The Nova-WPF and the Nova-UPF scores were computed by adding up positive responses regarding the consumption of thirty-three varieties of WPF and twenty-three varieties of UPF, respectively. Participants reported their height at baseline and their weight at both baseline and after approximately 15 months of follow-up. A 15-month BMI (kg/m2) increase of ≥5 % was coded as BMI gain. Setting: Brazil. Participants: 9551 participants from the NutriNet-Brasil cohort. Results: Increasing quintiles of the Nova-UPF score were linearly associated with higher risk of BMI gain (relative risk Q5/Q1 = 1·34; 95 % CI 1·15, 1·56), whereas increasing quintiles of the Nova-WPF score were linearly associated with lower risk (relative risk Q5/Q1 = 0·80; 95 % CI 0·69, 0·94). We identified a moderate inverse correlation between the two scores (–0·33) and a partial mediating effect of the alternative score: 15 % for the total effect of the Nova-UPF score and 25 % for the total effect of the Nova-WPF score. Conclusions: The Nova-UPF and Nova-WPF scores are independently associated with mid-term BMI gain further justifying their use in diet quality monitoring systems. [ABSTRACT FROM AUTHOR]

Objective: We assessed the ability of the Prime Diet Quality Score (PDQS) to predict mortality in the US population and compared its predictiveness with that of the Healthy Eating Index-2015 (HEI-2015).Design: PDQS and HEI-2015 scores were derived using two 24-h recalls and converted to quintiles. Mortality data were obtained from the 2015 Public-Use Linked Mortality File. Associations between diet quality and all-cause mortality were evaluated using multivariable Cox proportional hazards models, and predictive performance of the two metrics was compared using a Wald test of equality of coefficients with both scores in a single model. Finally, we evaluated associations between individual metric components and mortality.Setting: A prospective analysis of the US National Health and Nutrition Examination Survey (NHANES) data.Participants: Five-thousand five hundred and twenty-five participants from three survey cycles (2003-2008) in the NHANES aged 40 years and over.Results: Over the 51 248 person-years of follow-up (mean: 9·2 years), 767 deaths were recorded. In multivariable models, hazard ratios between the highest and lowest quintiles of diet quality scores were 0·70 (95 % CI 0·51, 0·96, Ptrend = 0·03) for the PDQS and 0·77 (95 % CI 0·57, 1·03, Ptrend = 0·20) for the HEI-2015. The PDQS and HEI-2015 were similarly good predictors of total mortality (Pdifference = 0·88).Conclusion: Among US adults, better diet quality measured by the PDQS was associated with reduced risk of all-cause mortality. Given that the PDQS is simpler to calculate than the HEI-2015, it should be evaluated further for use as a diet quality metric globally. [ABSTRACT FROM AUTHOR]

A range of metrics have been developed and used to measure components of dietary patterns (e.g., adequacy, quality, diversity). However, no existing dietary metric simultaneously captures the three key dimensions of sustainable healthy diets recommended by the Food and Agriculture Organization of the United Nations and the World Health Organization: food processing; dietary diversity; and intake of animal products(1). This study aimed to identify indicators of a global sustainable healthy diet and translate these features into a multidimensional diet quality score (SUSDIET). Informed by our scoping review(1), a Delphi method was adopted in the form of a three-round online survey of 13 national and international experts in nutritional epidemiology, environmental health, dietary assessment and/or food and nutrition policy. Surveys were conducted between November 2022 and May 2023. Participants were asked about procedures to establish an operational definition for a global sustainable healthy diet. Based on consensus from global experts, we developed the SUSDIET, a food-based diet quality score incorporating variety of plant foods, intake of animal products, and dietary contribution of ultra-processed foods (the 'dimensions'). Categories and amounts of foods consumed were informed by the Global Diet Quality Score(2), EAT Lancet Planetary Health(3) and a meta-analysis of the relationship between ultra-processed foods and all-cause mortality(4). The variety of plant foods is measured based on 12 food groups (citrus fruits, deep orange fruits, other fruits, dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, other vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, white roots and tubers), animal intake based on 5 food groups (egg, dairy, poultry, fish and seafood, red meat), and ultra-processed foods as one food group. Three categories of consumed amounts (in grams per day) are defined for variety of plant foods and animal intake, scoring as 0, 0.5 or 1. Ultra-processed food consumption is scored as 0 or 1 using ≤10% or >10% of total dietary intake as cut-offs. The components of each dimension are weighted so the three dimensions equally range from 0-5. SUSDIET overall score ranges from 0-15 (up to 5 points per dimension), with a higher score indicating a more healthy and sustainable diet. SUSDIET will be of immediate use for research aiming to assess the impact of diets on both health and environmental sustainability outcomes among the general adult population. This multidimensional diet quality score can also be used to inform and assess the effectiveness of policy actions that promote sustainable healthy diets, including the monitoring and surveillance of diets globally. [ABSTRACT FROM AUTHOR]

Background: The Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related noncommunicable disease risk in diverse populations. A software application (GDQS app) was recently developed for the standardized collection of GDQS data. The application involves a simplified 24-h dietary recall (24HR) where foods are matched to GDQS-food groups using an onboard database, portion sizes are estimated at the food group level using cubic models, and the GDQS is computed., Objectives: The study aimed to estimate associations between GDQS scores collected using the GDQS app and nutrient adequacy and metabolic risks., Methods: In this cross-sectional study of 600 Thai males and nonpregnant/nonlactating females (40-60 y), we collected 2 d of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between application scores and outcomes were estimated using multiple regression, and application performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity-Women, Alternative Healthy Eating Index-2010, and Global Dietary Recommendations score., Results: In covariate-adjusted models, application scores were significantly (P < 0.05) associated with higher energy-adjusted mean micronutrient adequacy computed using 24HR (range in estimated mean adequacy between score quintiles 1 and 5: 36.3%-44.5%) and FFQ (Q1-Q5: 40.6%-44.2%), and probability of protein adequacy from 24HR (Q1-Q5: 63%-72.5%). Application scores were inversely associated with BMI kg/m 2 (Q1-Q5: 26.3-24.9), body fat percentage (Q1-Q5: 31.7%-29.1%), diastolic blood pressure (Q1-Q5: 84-81 mm Hg), and a locally-developed sodium intake score (Q1-Q5: 27.5-24.0 points out of 100); positively associated with high-density lipoprotein cholesterol (Q1-Q5: 49-53 mg/dL) and 24-h urinary potassium (Q1-Q5: 1385-1646 mg); and inversely associated with high midupper arm circumference (Q5/Q1 odds ratio: 0.52) and abdominal obesity (Q5/Q1 odds ratio: 0.51). Significant associations for the application outnumbered those for metrics computed using 24HR or FFQ., Conclusions: The GDQS app effectively assesses nutrient adequacy and metabolic risk in population surveys., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Comprehensive metrics that provide a measure of dietary patterns at global and national levels are needed to inform and assess the effectiveness of policy actions that promote sustainable healthy diets. In 2019, the Food and Agriculture Organization of the United Nations and the World Health Organization reported 16 guiding principles of sustainable healthy diets, but it is still unknown how these principles are considered in dietary metrics. This scoping review aimed to explore how principles of sustainable healthy diets are considered in dietary metrics used worldwide. Forty-eight food-based, investigator-defined dietary pattern metrics assessing diet quality in free-living, healthy populations at the individual or household level were assessed against the 16 guiding principles of sustainable healthy diets, which was used as a theoretical framework. A strong adherence of the metrics to health-related guiding principles was found. Metrics had a weak adherence to principles related to environmental and sociocultural aspects of diets, except for the principle related to diets being culturally appropriate. No existing dietary metric captures all principles of sustainable healthy diets. Notably, the significance food processing, environmental, and sociocultural aspects of diets are generally understated. This likely reflects the lack of focus on these aspects in current dietary guidelines, which highlights the importance of including these emerging topics in future dietary recommendations. The absence of quantitative metrics that comprehensively measure sustainable healthy diets limits the body of evidence that would otherwise inform national and international guideline developments. Our findings can help grow the quantity and quality of the body of evidence available to inform policy activities to realize 2030 Sustainable Development Goals of multiple United Nations. Adv Nutr 2022;x:xx., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: In India, there is a need to monitor population-level trends in changes in diet quality in relation to both undernutrition and noncommunicable diseases.Objectives: We conducted a study to validate a novel diet quality score in southern India.Methods: We included data from 3041 nonpregnant women of reproductive age (15-49 years) from 2 studies in India. Diet was assessed using a validated food frequency questionnaire (FFQ). The Global Diet Quality Score (GDQS) was calculated from 25 food groups (16 healthy; 9 unhealthy), with points for each group based on the frequency and quantity of items consumed in each group. We used Spearman correlations to examine correlations between the GDQS and several nutrient intakes of concern. We examined associations between the GDQS [overall, healthy (GDQS+), and unhealthy (GDQS-) submetrics] and overall nutrient adequacy, micro- and macronutrients, body mass index (BMI), midupper arm circumference, hemoglobin, blood pressure, high density lipoprotein (HDL), and total cholesterol (TC).Results: The mean GDQS was 23 points (SD, 3.6; maximum, 46.5). In energy-adjusted models, positive associations were found between the overall GDQS and GDQS+ and intakes of calcium, fiber, folate, iron, monounsaturated fatty acid (MUFA), protein, polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), total fat, and zinc (ρ = 0.12-0.39; P < 0.001). Quintile analyses showed that the GDQS was associated with better nutrient adequacy. At the same time, the GDQS was associated with higher TC, lower HDL, and higher BMI. We found no associations between the GDQS and hypertension.Conclusions: The GDQS was a useful tool for reflecting overall nutrient adequacy and some lipid measures. Future studies are needed to refine the GDQS for populations who consume large amounts of unhealthy foods, like refined grains, along with healthy foods included in the GDQS. [ABSTRACT FROM AUTHOR]

Background: Evidence on concurrent changes in overall diet quality and weight and waist circumference in women of reproductive age from low- and middle-income countries is limited.Objectives: We examined the associations of changes in the Global Diet Quality Score (GDQS) and each GDQS food group with concurrent weight and waist circumference change in Mexican women.Methods: We followed prospectively 8967 nonpregnant nonlactating women aged 25-49 y in the Mexican Teachers' Cohort between 2006 and 2008. We assessed diet using an FFQ of the previous year and anthropometric measures were self-reported. Regression models were used to examine 2-y changes in the GDQS and each food group (servings/d) with weight and waist circumference changes within the same period, adjusting for demographic and lifestyle factors.Results: Compared with those with little change in the GDQS (-2 to 2 points), women with the largest increase in the GDQS (>5 points) had less weight (β: -0.81 kg/2 y; 95% CI: -1.11, -0.51 kg/2 y) and waist circumference gain (β: -1.05 cm/2 y; 95% CI: -1.62, -0.48 cm/2 y); likewise, women with the largest decrease in the GDQS (<-5 points) had more weight (β: 0.36 kg/2 y; 95% CI: 0.06, 0.66 kg/2 y) and waist circumference gain (β: 0.71 cm/2 y; 95% CI: 0.09, 1.32 cm/2 y). Increased intake of dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, citrus fruits, and fish and shellfish was associated with less weight gain. In addition, deep orange vegetables, low fat and high fat dairy, whole grains, and fish were associated with less waist circumference gain within the 2-y period.Conclusions: Improvements in diet quality over a 2-y period reflected by an increase in the GDQS and changes in consumption of specific components of the GDQS were associated with less weight and waist circumference gain in Mexican women. [ABSTRACT FROM AUTHOR]

Background: Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising.Objectives: To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults.Methods: We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models.Results: In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia.Conclusions: The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS' performance in capturing NCD outcomes in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups.Objectives: We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings.Methods: Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics.Results: We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes).Conclusions: The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project. [ABSTRACT FROM AUTHOR]

Background: Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden.Objectives: We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults.Methods: We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models.Results: Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive.Conclusions: The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA. [ABSTRACT FROM AUTHOR]