Development of a Diet Quality Score for Infants and Toddlers and its Association with Weight

Abstract

Objective To create a Diet Quality Index Score (DQIS) for infants and toddlers and to assess its relative validity. Design Three DQIS were created (0–5, 8–11 and 12–24 months) based on a validated food frequency questionnaire (FFQ). Nine components were included, scored from 0 (inadequate) to 5 (adequate consumption) based on guidelines for timing of food’s introduction and portion sizes; the component on breastfeeding (Yes/No) was scored (0–15). Infants 6–7 months were excluded as new foods are introduced during this period. The total score (0–55 points) was categorized as Excellent (≥45), Good (35–44), Needs improvement (25–34), and Poor (<25). Relative validity was assessed against weight status among a sample of 296 children using logistic regression. Results In infants 0–5 months (n=100), mean DQIS was 42.4±9.3 and 52% had ‘Excellent’ diets. In infants 8–11 months (n=42), mean DQIS was 36.1±7.7 and most had ‘Good’ diets (47.6%). Among toddlers 12–24 months (n=117), mean DQIS was 25.7±8.0 and most had ‘Poor’ diets (50.4%). There was a trend for a higher odd of Excessive weight in those with ‘Poor’ diets compared to those with ‘Excellent’ diets, after controlling for confounders (OR 2.01; 95% CI: 0.85, 5.18). Conclusions These scores could be used to assess diet quality in infants and toddlers. There was a trend for a higher odd of Excessive weight among those with ‘Poor’ diets. To our knowledge, this is the first algorithm for the assessment of diet quality in infants and toddlers considering intake of each food group and their portion sizes.

The Development and Evaluation of a Diet Quality Index for Asian Toddlers and Its Perinatal Correlates: The GUSTO Cohort Study

“…Despite considerable interest in the diet quality of children, particularly those below 2 years of age [9], diet quality indices are relatively less developed in pediatric populations compared to adult populations [8]. Dietary intakes in the first two years of life are varied and less stable as toddlers are introduced to many new food and beverages during this period [10]. It may be difficult to quantify toddlers’ portion sizes as food wastage and fussy eating are prevalent among this age group.…”

“…Moreover, food-based dietary guidelines with quantifiable recommendations for children below 2 years old are limited internationally [11]. Existing studies in Western countries (e.g., Netherlands [12], Puerto Rico [10] and Australia [13,14]) where diet quality indices for children have been developed and validated have demonstrated that lower index scores were generally associated with unhealthy maternal lifestyle factors such as smoking during pregnancy [12], tended to associate with higher risk of excessive weight status in toddlers [10], shorter breastfeeding duration and greater food neophobia behavior [13]. However, to our knowledge, no diet quality index has been developed for Asian toddlers in a developed country.…”

Indexes to assess feeding practices of children under 2 years old: a systematic review

“…The studies included in the qualitative synthesis were published between 2000 and 2020, with the majority (n 26) after 2010 (26,27,29,(31)(32)(33)(34)(35)(36)(37)(38)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(52)(53)(54)56) . Six studies were published between 2019 and 2020 (27,37,42,45,50,53) .…”

“…Twenty-four studies employed a cross-sectional design (10,(25)(26)(27)(28)(29)31,32,34,37,38,40,43,44,48,49,(52)(53)(54)(56)(57)(58)(59) , six were longitudinal studies (36,39,42,(45)(46)(47) , five were intervention studies (30,33,35,41,50) and one presented cross-sectional and longitudinal analyses (55) .…”

“…Twelve studies were conducted in Asian countries (27,34,39,44,45,49,51,(55)(56)(57)(58)(59) , ten in Latin America (10,32,33,35,37,38,40,48,50,54) , four studies in Europe (29)(30)(31)43) , four in North America (28,42,46,53) , three in Oceania (26,36,41) and three in Africa (25,47,52) . Only two studies (10,52) evaluated data from more than one country.…”