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diet quality index
Also known as: diet quality indices, dietary indices, Dietary index, Dietary Quality Indices, DQIs, diet-quality indexes
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How do the indices based on the EAT-Lancet recommendations ... medrxiv.org May 14, 2024 29 facts
claimKappa coefficients indicated only slight or fair concordance between the dietary indices analyzed.
measurementThe study evaluated six dietary indices for assessing adherence to the EAT-Lancet reference diet using food consumption data from 1,723 adults obtained from the French Third Individual and National Study on Food Consumption Survey (INCA3) conducted between 2014 and 2015.
claimDietary indices used to measure adherence to EAT-Lancet recommendations vary primarily in their scoring systems, food components, units, energy adjustments, and cut-off points.
claimCurrent dietary indices assign equal weights to all food components despite variations in their impact on health and the environment, suggesting a potential improvement by assigning different weights to better reflect their relative impact.
claimDietary indices utilizing binary or semi-quantitative scoring systems are negatively associated with nutritional adequacy for several nutrients.
measurementIn the study of dietary indices, poultry, potatoes, dairy, and added sugars received the highest scores, while whole grains, nuts, legumes, unsaturated oils, beef, lamb, and pork received lower scores.
claimDietary indices for EAT-Lancet adherence have valid unidimensional structures, meaning the combination of food components within each index accurately reflects the same construct, supporting the use of total scores.
claimDietary indices that assess food components with quantitative scoring captured dietary variability, were less dependent on energy intake, and converged to a large extent with nutritional indicators.
claimDifferences in index scores according to sociodemographics support the concurrent criterion validity of the indices.
referenceThe authors recommend following the framework provided by Waijers et al. to establish clear criteria for food component contribution in dietary indices.
measurementHigher scores on dietary indices were associated with higher nutritional quality and lower environmental impact, but were associated with unfavourable results for zinc intake, vitamin B12, and water use.
measurementOlder age groups scored higher on all dietary indices analyzed in the study.
measurementIndividuals in lower BMI groups had higher scores on dietary indices, though this trend was only confirmed for ELD-I and ELI.
claimDietary indices based on binary scoring offer a simplified perspective and are valuable tools for surveys, observational studies, and public health.
procedureTo assess the homogeneity of food components within dietary indices, Pearson’s correlation is used for quantitative indices, polychoric correlation for semi-quantitative scales, and tetrachoric correlation for dichotomous data.
procedureInternal consistency reliability of a dietary index is assessed by calculating Guttman’s lambda (λ) coefficients, which include six measures (λ1-λ6) based on total variance, component variance, and covariance.
measurementBetween 23% and 28% of participants were classified in adjacent quintiles or quartiles across the dietary indices analyzed.
claimMost items contributed significantly to total scores in the dietary indices, with the exceptions of chicken and poultry in the ELD-I, legumes in the HSDI, and soy foods in the ELDS.
claimIt is recommended that the use of total scores in dietary indices be complemented by a detailed analysis of the food components.
claimAll inter-component correlations for the dietary indices were below 0.80, which suggests an absence of redundancy between components.
procedureThe concordance between indices was analyzed by determining the proportion of participants classified in the same, adjacent, or opposite extreme quintiles relative to the total score, using quartiles for binary indices to avoid imbalanced categories.
measurementTotal concordance among dietary indices (individuals classified in the same quintile or quartile) was below 50% for all paired comparisons in the study.
measurementThe classification percentages of participants in the opposite extreme quintile or quartile across dietary indices ranged from 1% to 7.5%.
measurementA low concordance rate ranging from 32% to 43% indicated that different dietary indices categorized individuals differently regarding their adherence to the EAT-Lancet reference diet.
measurementIndividuals with higher income had higher scores in all dietary indices analyzed, with the exception of HSDI.
claimIn dietary indices, fruits and vegetables demonstrate robust correlations with total scores, underscoring their importance in evaluating both health and sustainability, whereas whole grains and legumes exhibit weaker correlations.
procedureThe construction of a dietary index requires six key considerations: 1) a clear objective, 2) a rationale for the choice of index components, 3) clear information on assigning foods to food groups, 4) exact quantification of index components against cut-off values, 5) a decision on energy adjustment, and 6) information on the relative contribution of individual components to the total score.
claimDietary indices using quantitative scoring are advantageous in precision-focused research, such as clinical trials or epidemiological research, because they allow a global understanding of dietary health and sustainability.
claimDietary indices are sensitive to capturing dietary cultural variability, as evidenced by differences in scores between studies reflecting variations in regional consumption patterns.
Dietary Guidelines and Quality - Principles of Nutritional Assessment nutritionalassessment.org 21 facts
referenceDiet quality indices developed or adapted for children and adolescents were reviewed by Dalwood et al. in 2020.
procedureEvaluating diet quality indices requires assessing whether the index is well-grounded in theory, covers all dimensions of interest (content validity), performs consistently with theory (construct validity), and determines how to weight adequacy components relative to moderation components.
claimMost diet quality indices were historically developed for adult populations in high-income countries and rely on quantitative dietary recall data from food frequency questionnaires or 24-hour recalls, requiring comprehensive food composition data.
claimMost diet quality indices require quantitative dietary intake data from sources such as food frequency questionnaires or quantitative 24-hour recalls, which is resource-intensive to obtain.
referenceDiet quality indices may be designed to capture one or more of the following characteristics: food group consumption (quantities, diversity, balance), macronutrient balance (percent of energy from protein, carbohydrates, and fat), nutrient density (nutrients per 1000kcals), nutrient adequacy relative to requirements, moderation in consumption of foods that elevate NCD risk, adherence to dietary patterns designed to minimize NCD risk, adherence to healthy cultural dietary patterns, environmental impact/sustainability, and adherence to dietary guidance from national or global health authorities.
claimRecent initiatives have aimed to develop lower-burden proxy indices for global or national monitoring that measure specific diet quality characteristics with less costly data requirements than traditional quantitative dietary recall methods.
claimThe 'Mean Adequacy Ratio' developed by Guthrie et al. in 1972 is an early example of a diet quality index that focused exclusively on summarizing nutrient adequacy.
claimThe construct validity of dietary indices for infants, young children, and women of reproductive age was evaluated by comparing these indices to micronutrient density or dietary adequacy using data sets from studies in multiple low- and lower-middle-income countries.
procedureWhen scoring diet quality indices, researchers must decide whether to use absolute criteria or relative criteria (such as study-specific distributions of intake), whether to adjust scoring for different age or sex groups, how to assign points per component, and whether to use dichotomous or proportional scoring methods.
procedureWhen constructing diet quality indices, researchers must determine if all components should be weighted equally or if some components should be given heavier weight based on known associations with health benefits or risks.
claimLower-burden diet quality indices are based on food groups and/or behavioral questions, do not include nutrient intakes for calculation, and do not require food composition data for tabulation.
procedureThe development of diet quality indices requires researchers to make several methodological decisions, including selecting component parts (foods, food groups, nutrients, or substances like fiber or polyphenols), determining classification rules (e.g., whether potatoes count as vegetables or juice counts as fruit), and deciding whether to measure intake in absolute terms (grams) or relative terms (grams per 1000kcals).
referenceRecent reviews of diet quality indices include studies by Burggraf et al. (2018), Trijsburg et al. (2019), Aljuraiban et al. (2020), and Miller et al. (2020).
claimThe percent of energy from ultra-processed foods (UPF) index differs from other diet quality indices by focusing on a single characteristic—processing level—which applies across all food and beverage groups.
claimDiet quality indices are based on national or global dietary guidelines, or assessments of evidence related to nutritional adequacy, diet-health relationships, and environmental sustainability.
claimModern diet quality indices have evolved to reflect multiple characteristics, including nutrient adequacy, non-communicable disease (NCD) risk, and increasingly, sustainability concerns.
claimLower-burden diet quality indices have been developed for global and national monitoring in resource-constrained contexts where quantitative dietary intake data is unavailable.
referenceDiet quality indices are used for assessment and monitoring (describing diet quality for individuals or populations, estimating distributions, and describing trends over time), epidemiological research (examining associations between diet quality and dependent or independent variables), and programmatic/policy uses (targeting programs, assessing intervention effects, and informing policy development).
claimSeveral food group diversity indicators have been developed as simple proxies for micronutrient adequacy for use when more complex diet quality indices are not feasible.
claimLiterature reviews have identified hundreds of diet quality indices, which vary in scope from study-specific or context-specific applications to those proposed for national, regional, or global use, as documented by Burggraf et al. (2018), Trijsburg et al. (2019), Aljuraiban et al. (2020), and Miller et al. (2020).
measurementA difference or change in diet quality index scores of approximately one-half of a standard deviation is considered a moderate effect size.
Diet Quality Indices: Measures for Bridging Nutrition and Public Health link.springer.com 2 days ago 10 facts
claimDiet quality indices are dynamic tools that evolve alongside advances in health evidence and offer flexibility for adaptation to various contexts and populations through validation processes.
referenceHlaing-Hlaing H, Pezdirc K, Tavener M et al. (2020) conducted a systematic review and critical appraisal of diet quality indices used in Australian and New Zealand adults, published in Nutrients 12(12):3777.
claimDiet quality indices serve as instruments for public health research and policies by offering insights into diet-related health risks and supporting decisions for resource allocation in food and nutritional security.
claimChiuve et al. (2012) found that alternative dietary indices strongly predict the risk of chronic disease.
referenceThe chapter 'Diet Quality Indices: Measures for Bridging Nutrition and Public Health', authored by Fisberg, R.M., Félix, P.V., Pereira, J.L., Norde, M.M., de Mello, A.V., and Bastos, A.A., was published in the Handbook of Public Health Nutrition by Springer in 2025.
claimDiet quality indices are tools used in nutritional epidemiology to investigate associations between diet and health outcomes and to track vulnerable areas and strata in different populations.
claimBrlek and Gregorič (2023) performed an umbrella review finding associations between diet quality indices and all-cause mortality, cardiovascular disease, and type 2 diabetes mellitus.
claimThe authors of the manuscript 'Diet Quality Indices: Measures for Bridging Nutrition and Public Health' declare that they have no competing interests relevant to the content of the manuscript.
claimDiet quality indices are frequently based on dietary guidelines or empirically derived dietary patterns, utilizing nutrient-based or food-based approaches.
referenceZhan JJ, Hodge RA, Dunlop AL, and colleagues developed 'Dietary index', an R package designed to standardize dietary pattern analysis for use in epidemiological and clinical studies, published in the American Journal of Clinical Nutrition in 2024.
A Scoping Review of Indicators for Sustainable Healthy Diets frontiersin.org Jan 12, 2022 4 facts
measurementOf 81 diet quality indices identified by Trijsburg et al. (2019), only 18 were eligible for use in low- and middle-income countries, and of those 18, 16 failed to capture three important dimensions of diet quality (adequacy, diversity, and moderation), while the remaining two were country-specific.
referenceVerger et al. (2012) evaluated a diet quality index based on the probability of adequate nutrient intake (PANDiet) using national French and US dietary surveys.
claimComposite indices such as healthy eating indices, the Health Score, and the Diet Quality Index are justified because they are based on national dietary guidelines and assess overall diets beyond single nutrients, which is important for the reduction of obesity and diet-related non-communicable diseases (Carvalho et al., 2013; Wrieden et al., 2019; Rose et al., 2019; Van Dooren et al., 2014).
referenceTrijsburg et al. (2019) published 'Diet quality indices for research in low-and middle-income countries: a systematic review' in Nutrition Reviews, reviewing indices used to measure diet quality in specific economic contexts.
Global dietary quality in 185 countries from 1990 to 2018 show wide ... nature.com Sep 19, 2022 3 facts
referenceDiet-quality indexes are associated with a lower risk of cardiovascular, respiratory, and all-cause mortality among Chinese adults according to a 2018 study by Neelakantan et al. published in the Journal of Nutrition.
referenceA 2014 systematic review by Marshall et al. published in the Journal of Human Nutrition and Dietetics examined diet quality indices and their associations with health-related outcomes in children and adolescents.
referenceA 2018 study by Chen et al. published in the American Journal of Epidemiology investigated the association between diet quality indices and the risk of type 2 diabetes mellitus within the Singapore Chinese Health Study.
Review of Diet Quality Indices that can be Applied to the ... - PMC pmc.ncbi.nlm.nih.gov 1 fact
referenceThe review titled 'Review of Diet Quality Indices that can be Applied to the ...' identified five major groups of diet quality indices: nutrient-food quantity-based, guideline-based, diversity-based, nutrient quality-based, and health-based.
The Dietary Patterns Methods Project: Synthesis of Findings across ... sciencedirect.com 1 fact
claimThe Dietary Patterns Methods Project (DPMP) was initiated in 2012 with the goal of strengthening research evidence regarding dietary indices, dietary patterns, and health.
Scoping Review of Dietary Quality Indices - Oxford Academic academic.oup.com Nov 29, 2025 1 fact
claimHigher diet quality, as assessed by prioritized Dietary Quality Indices (DQIs), is generally associated with favorable health outcomes according to the Scoping Review of Dietary Quality Indices.
Measuring Adherence to Sustainable Healthy Diets - ResearchGate researchgate.net 1 fact
claimA range of metrics, such as the Diet Quality Index, has been developed to measure the healthiness of diets.