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

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.

Adjusting DBI-2016 to dietary balance index for Chinese maternal women and assessing the association between maternal dietary quality and postpartum weight retention: A longitudinal study

“…The dietary quality depends on the existing dietary patterns, which were assessed generally by two approaches: a priori method based on prior nutrition knowledge translated into dietary guidelines, and posteriori method, in which dietary patterns are extracted once the dietary intake are investigated [ 9 ]. In the a priori method, the diet quality indices are constructed to quantify the healthiness of the dietary pattern based on existing scientific guideline [ 9 ].…”

“…To our knowledge, this study was the first assessment of overall dietary quality using diet index method for Chinese puerperal women, and other investigations usually analyzed individual nutrients and food groups separately. The dietary quality depends on the existing dietary patterns, which were assessed generally by two approaches: a priori method based on prior nutrition knowledge translated into dietary guidelines, and posteriori method, in which dietary patterns are extracted once the dietary intake are investigated [9]. In the a priori method, the diet quality indices are constructed to quantify the healthiness of the dietary pattern based on existing scientific guideline [9].…”

“…The dietary quality depends on the existing dietary patterns, which were assessed generally by two approaches: a priori method based on prior nutrition knowledge translated into dietary guidelines, and posteriori method, in which dietary patterns are extracted once the dietary intake are investigated [9]. In the a priori method, the diet quality indices are constructed to quantify the healthiness of the dietary pattern based on existing scientific guideline [9]. We have finished assessing dietary patterns of Chinese puerperal women in the same cohort (manuscript under submission), and identified four dietary patterns through a posterior principal component analysis, including "plant food" pattern (characterized by high intake of rice and vegetables), "diverse" pattern (characterized by starchy roots, fruit, livestock meat and aquatic products, relatively healthy), "traditional northern" pattern (poultry meat, eggs and soup), and "marine-flour" pattern (flour, coarse food grains and marine foods).…”

“…Given that dietary intake plays an important impact on maternal and offspring health, there have been growing interests in using dietary quality indices, such as Healthy Eating Index (HEI-2015) [6], Diet Quality Index (DQI) [7] and Mediterranean Diet Scale (MDS) [8], to evaluate the women's adherence to a balanced diet. Components included in diet quality indices are usually nutrient adequacy, food diversity, and moderation [9]. In China, several dietary quality indices have been developed, such as Chinese Healthy Eating Index [10], Chinese Dietary Balance Index 2016 (DBI-16) [11].…”

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis

“…For example, a healthy diet pattern in one study was high in vegetables, fruits, and dairy [15], while a healthy pattern in another study was high in vegetables, fruits, fish, crackers, and bread [17]. Diet indices have also been developed for diet quality assessment, however, these indices are shown to be weak predictors of CMR factors [18,19]. Identifying leading dietary determinants for changes in CMR factors using new methods is urgent for targeting intervention priorities for the prevention of CMR in children.…”