This article reviews the published indexes of overall diet quality. Approaches used for measuring overall diet quality include those based on examination of the intake of nutrients, food groups, or a combination of both. A majority of the indexes have been examined in relation to nutrient adequacy only; few have been evaluated for assessment of quality according to current dietary guidelines, namely, a diet relatively low in fat that meets energy and nutrient needs. The indexes of overall diet quality were related to the risk of disease more strongly than individual nutrients or foods. J Am Diet Assoc. 1996; 96:785–791.

Indexes of overall diet quality : A review

Objectives The failure of single-nutrient supplementation to prevent disease in intervention studies underlines the necessity to develop a holistic view of food intake. The objectives of this study were to devise a diet quality index (DQI) and identify biomarkers of multidimensional dietary behavior. Design A nutrition survey was conducted in Mediterranean southern France by means of a food frequency questionnaire. The DQI was based on current dietary recommendations for prevention of diet-related diseases such as cardiovascular disease and some cancers. A second DQI included tobacco use. Statistical analyses performed Spearman rank correlations, cross-classifications and intraclass correlations were computed between the DQI and biomarkers. Results Of the 146 subjects, 10 had a healthful diet and 18 had a poor diet. Erythrocyte Ω-3 fatty acids—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—beta carotene, and vitamin E concentrations were lower and cholesterol concentrations were higher in the poor diet; the difference was significant for EPA and DHA and borderline significant for vitamin E. Significant correlation was found between the DQI and vitamin E (−0.12), EPA (−0.30), and DHA (−0.28), and beta carotene (−0.17) when tobacco use was considered, but not between the DQI and cholesterol. The correlation coefficient reached 0.58 (P0.01) for a composite index based on all biomarkers except cholesterol. Conclusions Subjects with a beta carotene levels greater than l micromol/L, vitamin E greater than 30 micromol/L and EPA greater than 0.65% and DHA greater than 4% of fatty acids in erythrocytes were likely to have a healthful diet. Each biomarker indicated the quality of diet, but correlation was higher with a composite index. Am Diet Assoc. 2000; 100:1164-1171 .

Profiles of a Healthful Diet and its Relationship to Biomarkers in a Population Sample from Mediterranean Southern France

Groupe d’Epide´miologie Me´tabolique, INSERM-CRLC, 34298 Montpellier Cedex 5, FranceSubmitted 17 January 2000: Accepted 7 July 2000AbstractObjective: A Mediterranean diet quality index (MDQI) was devised to give an overallassessment of dietary habits and to identify groups at risk.Design: The MDQI was based on scores given for selected levels of consumption ofselected nutrients and foods.Setting: Mediterranean southern France.Subjects: The sample included 473 men and 491 women in three age classesrecruited at random.Results: Only 9.5% of men, 9.0% of women, 4.7% of 20–34 year old subjects, 6.6% of35–54 year old subjects and 14.0% of 55–76 year old subjects were shown to have ahealthy diet. However, 10.1% of men, 8.6% of women, 19.4% of 20–34 year oldsubjects, 10.2% of 35–54 year old subjects and 4.6% of 55–76 year old subjects wereshown to have a poor diet. There were significantly fewer smokers among subjectswith a good diet but the distribution of moderate wine drinkers was comparablebetween those with a good diet and those with a poor diet. Correspondence analysisassociated a healthy diet with 55–76 year old men and women living in rural areas,who had received primary schooling only and who were manual workers. Both menand women with a poor MDQI score tended to be young and smokers. In addition,women with a poor MDQI tended to be heavy drinkers and obese.Conclusions: This study showed that the Mediterranean model, which is generallyrecognized as a healthy diet, appears restricted to older people and to rural areas,whereas urbanized young people depart from it. A nutritional prevention policytargeted at young adults is required to encourage them to adhere to theMediterranean model. Smoking and drinking showed different distribution patternsin the sample under study.KeywordsDiet Quality IndexDiet profilesMediterranean dietA growing body of evidence, including the failure ofsingle-nutrient supplementation in protecting againstcardiovascular disease

/pdf/diet-profiles-in-a-population-sample-from-mediterranean-2fmo490xoa.pdf

Diet profiles in a population sample from Mediterranean southern France

Traditionally, healthful diets and lifestyles have been examined only in relation to single nutrients, foods, or food groups in terms of dietary exposure. An alternative approach is to conceptualize an index based on vegetarian food pyramid guidelines as a measure of overall diet and lifestyle quality. Our objectives were to: (1) develop the Vegetarian Lifestyle Index (VLI); and (2) evaluate adherence to the Vegetarian Food Guide Pyramid (VFGP) among a low-risk population of Adventists. The index was based on the operationalization of 14 dietary and lifestyle components. All components were equally weighted. Higher score reflected greater adherence to the VFGP. The analytic sample (n = 90,057) comprised 47.7% non-vegetarians, 5.6% semi-, 10.1% pesco-, and 29.0% lacto-ovo-vegetarians, and 7.7% vegans, of which 1.1% were current smokers and 9.9% were alcohol consumers. Population mean VLI score was 7.43 (SD = 1.75) ranging from 1 to 12.5. Non-vegetarians (6.14; 95% confidence interval (CI), 6.06–6.21) had a significantly lower mean compared to semi- (7.31; 95% CI, 7.22–7.40), pesco- (7.41; 95% CI, 7.32–7.49), and lacto-ovo-vegetarians (8.16; 95% CI, 8.08–8.24), as well as vegans (8.88; 95% CI, 8.78–8.96). Vegetarians scored on average 1.18 to 2.73 more points than their non-vegetarian counterparts. Results demonstrate that the index has strong discriminant ability across distinct dietary patterns. Additionally, the VLI provides a useful measure of diet and lifestyle adherence to further refine vegetarian food pyramid guidelines.

https://www.mdpi.com/2072-6643/10/5/542/pdf

The Design, Development and Evaluation of the Vegetarian Lifestyle Index on Dietary Patterns among Vegetarians and Non-Vegetarians

Background: An index of diet quality, which examines different aspects of a diet concurrently, may facilitate the identification of poor dietary habits in population sub-groups. The objectives of the present study were to develop a food frequency index (FFI) and to test its associations with nutritional biomarkers and nutrient intake.



Methods:  The study comprised a cross-sectional survey among 444 adults aged 55 years and older in Vienna, Austria, and a sub-sample of 226 subjects who provided fasting blood specimen. Data from a qualitative 28-item food-frequency questionnaire were used to develop the FFI.



Results:  FFI scores were positively correlated with plasma concentrations of beta-carotene (r = 0.26), beta-cryptoxanthin (r = 0.31), zeaxanthin (r = 0.19), lutein (r = 0.21), phylloquinone (r = 0.19), 25-hydroxyvitamin D (r = 0.20), and serum high-density lipoprotein (HDL)-cholesterol (r = 0.24) and were negatively correlated with the ratio of total : HDL-cholesterol (r = −0.23). Sub-groups with higher FFI scores had, on average, lower intakes of total fat, saturated fat, and dietary cholesterol and higher intakes of total carbohydrates, dietary fibre, and most of the examined micronutrients.



Conclusion:  The FFI as a measure of diet quality has the ability to discern population sub-groups, with reasonable validity, into low- or high-risk dietary habits.

Development and validation of a food frequency index using nutritional biomarkers in a sample of middle-aged and older adults.

Dietary goals are usually expressed in the form of consumption of absolute quantities of specific nutrients. Translating such information into food patterns is difficult. Consequently it is not easy to convey these goals in the promotion of a healthy diet or to monitor dietary change in populations. This paper explores the difficulties and advantages of a food frequency questionnaire approach as used in a large regional health survey to describe food patterns and hence to monitor change in relation to dietary variables. There was considerable variation in the frequency of consumption of individual foods between different sub-groups in the population and these were as expected. To assess the overall diet a composite dietary index was proposed. The index score was significantly associated with various socio-demographic and lifestyle variables. Unhealthy lifestyles were associated with low scores (i.e. an ‘unhealthy’ diet) on the index indicating a measure of validity. However there were several limitations in the food frequency questionnaire method used: neither the questionnaire nor simple global indices of a ‘healthy’ diet derived from the questions used had been validated against a more robust quantifiable measure of diet; some of the questions were not specific for population groups of interest; some questions grouped foods in categories that masked differences in consumption and several did not correspond to recent food targets; and finally there was no energy adjustment, which meant that the obese appeared to have a healthy dietary pattern. The use of a valid set of food frequency questions as an efficient and practical way of monitoring a population's diet by survey is suggested. The questions must be validated against reliable measures of nutrients, and be compatible with food targets based on nutritional recommendations.

Monitoring dietary change in populations and the need for specific food targets; lessons from the North West Thames Regional Health Survey

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Monitoring dietary change in populations and the need for specific food targets; lessons from the North West Thames Regional Health Survey