Introducing a Suite of Low-Burden Diet Quality Indicators That Reflect Healthy Diet Patterns at Population Level

Abstract

Background Few low-burden indicators of diet quality exist, to track trends over time at low cost and with low technical expertise requirements. Objective To develop and validate a suite of low-burden indicators to reflect adherence to global dietary recommendations. Methods Using nationally representative cross-sectional quantitative dietary intake datasets from Brazil and the United States, we tested the association of food group scores with quantitative consumption aligned with 11 global dietary recommendations. We updated the Healthy Diet Indicator (HDI) to include current quantifiable recommendations of the World Health Organization (HDI-2020). We developed three food group-based scores: an overall Global Dietary Recommendations (GDR) Score as an indicator of all 11 recommendations, composed of two sub-components: GDR-Healthy, an indicator of the recommendations on “healthy” foods; and GDR-Limit, an indicator of the recommendations on dietary components to limit. We tested associations between these scores and the HDI-2020, and its respective subcomponents. We developed 9 dichotomous food group-based indicators to reflect adherence to the global recommendations for fruits and vegetables; dietary fiber; free sugars; saturated fat; total fat; legumes; nuts and seeds; whole grains; and processed meats. We conducted receiver-operating characteristic and sensitivity-specificity analyses to determine whether the dichotomous indicators were valid to predict adherence to the recommendations in both countries. Results The GDR Score and its subcomponents were moderately to strongly associated with the HDI-2020 and its respective subcomponents (absolute values of rank correlation coefficients ranged from 0.55 to 0.66). The dichotomous indicators largely met the criteria for predicting 8 of the global dietary recommendations in both countries; the indicator of total fat did not perform satisfactorily. Conclusions Food group consumption data can be used to indicate adherence to quantitative global dietary recommendations at population level. These indicators may be used to track progress of countries and populations toward meeting WHO guidance on healthy diets.

Predicting the 10-year Risk of Cardiovascular Diseases and Its Relation to Healthy Diet Indicator in Iranian Military Personnel

“…In this regard, we used its updated version (HDI-20) in order to cover the current and up-to-date recommendations of WHO. Note that investigation of the dietary quality has already been performed by HDI-2020 in previous studies (20). This index has an 11 items list with the score range of 0-11.…”

Priority micronutrient density in foods

“…Second, in addition to significant differences across FCTs, there is sometimes high nutrient-density variance across foods within food groups, meaning that the ranking of a food group as a whole might not reflect the micronutrient density of the most (or least) nutrient-dense foods included. However, we chose to maintain these levels of aggregation because our selected food groups are more likely to be targeted in programming and policies than individual foods and match more closely with food groups in upcoming global diet quality monitoring data 45,46 . Third, country and regional FCTs only included a limited set of commonly consumed foods, which limited the breadth of foods included in our aggregated food composition database.…”

Predicting the 10-year risk of cardiovascular diseases and its relation to healthy diet indicator in Iranian military personnel

“…We used the updated version (HDI-2020) of dietary recommendations for prevention of chronic disease published by the World Health Organization (WHO) to cover the last recommendations. Investigation of the dietary quality by HDI-2020 has been assessed in the previous studies [20]. HDI listhas eleven items with the score range of 0-11.…”