Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal

Abstract

Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.

Evaluation of Dietary Patterns and All-Cause Mortality

“…Although we believe this systematic review is the most comprehensive examination of US dietary patterns and ACM that is currently available, its findings align with the results of previous meta-analyses that focused on select diet types and/or cause-specific mortality. 9 , 10 , 11 , 12 , 172 …”

“…3 Other literature reviews have examined specific diets or foods and cause-specific mortality. 9 , 10 , 11 , 12 In line with these studies, the 2020 committee, 13 with support from the Nutrition Evidence Systematic Review (NESR) team of the US Department of Agriculture, conducted a systematic review of the literature to ascertain the association between dietary patterns consumed and all-cause mortality (ACM).…”

Effectiveness of a Motivational Nutritional Intervention through Social Networks 2.0 to Increase Adherence to the Mediterranean Diet and Improve Lung Function in Active Smokers: The DIET Study, a Randomized, Controlled and Parallel Clinical Trial in Primary Care

“…Predefined indices assess dietary patterns based on current nutrition knowledge and they have been developed primarily for nutritional epidemiology to assess dietary risk factors for noncommunicable diseases [ 57 ]. Similarly, the Healthy Eating Index (HEI), the Diet Quality Index (DQI), the Healthy Diet Indicator (HDI) and the Mediterranean Diet Adherence Score (MEDAS) are the four original diet quality scores that have been developed and most extensively validated [ 58 , 59 ]. Evaluating the dietary habits through questionnaires such as MEDAS, which has 14 items, could provide information about how our dietary habits influence lung health.…”

The Diet Quality and Nutrition Inadequacy of Pre-Frail Older Adults in New Zealand

“…Hlaing-Hlaing et al conducted a systematic review in 2017 to understand the breadth of diet quality indices used in adults in Australia and New Zealand [ 19 ]. Researchers found that of the 25 indices identified, only one was applied in New Zealand; the Healthy Dietary Habits Index (HDHI), and this was for adolescents [ 20 ].…”

“…Researchers found that of the 25 indices identified, only one was applied in New Zealand; the Healthy Dietary Habits Index (HDHI), and this was for adolescents [ 20 ]. In the reviewer’s critical appraisal, most of the indices used in Australia and New Zealand had been built for detecting over-nutrition [ 19 ]. Trijsburg et al, in their systematic review, suggested indices to cover both over- and under-nutrition to be applicable for different population groups and global comparison [ 21 ].…”