Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS)

Abstract

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.

Dietary Diversity and its Association with Nutritional Status, Cardiometabolic Risk Factors and Food Choices of Adults at Risk for Type 2 Diabetes Mellitus in Cape Town, South Africa

“…Although a diverse diet may be beneficial to health outcomes, studies show inconsistent results on the association of DD indicators with health outcomes. The recently developed Global Diet Quality Score (GDQS) is a more comprehensive population-level metric for both nutrient adequacy and diet-related NCD risk [ 61 ] may be a more suitable tool; however, the GDQS has not yet been validated in South Africa.…”

Seasonality and Day-to-Day Variability of Dietary Diversity: Longitudinal Study of Pregnant Women Enrolled in a Randomized Controlled Efficacy Trial in Rural Burkina Faso

“…Our study has some limitations that warrant caution. First, dietary diversity in isolation is not sufficient to reflect diet quality, which requires adequate and balanced macronutrient intakes and moderation in intakes of free sugars, sodium, and certain lipids ( 62 ). Second, qualitative, list-based, 24-hour recalls have been shown to overestimate (i.e., in particular, via false positives) the consumption of specific FGs, the FG diversity score, and the proportions of women achieving MDD-W, as compared to a weighed food record, among women of reproductive age in Cambodia, Ethiopia, and Zambia ( 58 ).…”

Assessing the Diets of Young Children and Adolescents in India: Challenges and Opportunities

“…For example, the DietSoft (Invincible Ideas, Noida, Uttar Pradesh, India) software for dietary calculations is targeted toward clinicians or businesses (restaurants, hotels, etc.) to estimate the nutritive value of 24 h recalls, custom recipes, and other food intakes ( 83 ). The database includes 1,205 common Indian food items including all foods in the India Food Composition Tables (IFCT) ( 75 ), the National Institute of Nutrition (NIN) Nutritive Value of Indian Foods list ( 76 ) and brand-name items.…”