Research
Diet quality index: Capturing a multidimensional behavior

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Abstract

Objective Data for 5,484 adults (aged 21 years and older) who participated in the 1987–1988 Nationwide Food Consumption Survey (NFCS) were used to develop an index of overall dietary intake that related to the major, diet-related, chronic diseases in the United States. The low response rate of the 1987–1988 NFCS has raised concerns about potential bias, but this large data set is useful for methodologic studies and research that does not attempt to generalize the results to the US population.

Analyses Dietary recommendations from the 1989 National Academy of Sciences publication Diet and Health were stratified into three levels of intake for scoring. Individuals who met a dietary goal were given a score of zero. Those who did not meet a goal, but had a fair diet, were given one point, and those who had a poor diet were give two points. These points were summed across eight diet variables to score the index from zero (excellent diet) to 16 (ppor diet).

Results Lower index scores were positively associated with high intakes of other important measures of diet quality (eg, fiber, vitamin C). We found that single nutrients (such as dietary fat) were not necessarily associated with other measures of diet quality.

Conclusion We concluded that this inex ranking of overall dietary patterns were reflective of total diet quality, though substantial misclassification can result from using single nutrients or foods as indicators of diet quality.

Section snippets

Subjects

The sample was composed of American adults surveyed in the 1987–88 Nationwide Food Consumption Survey (1987–88 NFCS) (11). The survey collected dietary, demographic, and socioeconomic data on stratified-area probability samples of noninstitutionalized US households in the 48 coterminous states. Individual dietary intakes were obtained for 3-day periods through a mix of 24-hour recall and 2-day food records.

The 1987–88 NFCS was designed as a self-weighting, multistage, stratified-area sample of

Diet and Health Recommendations

The percent of adults meeting the Diet and Health goals over a 3-day observation period is shown in Table 1. Only 14.8% of adults met the most important goal of keeping total fat intake to 30% or less of energy, and 16.1% met the goal of reducing saturated fatty acid intake to less than 10% of energy. Conversely, most Americans (61.7%) met the cholesterol goal of 300 mg per day. For complex carbohydrates, 21.7% and 22.6% of adults met the goals for fruits and vegetables (five or more servings

DISCUSSION

Our results indicate that DQI successfully triangulates in on overall diet quality by incorporating a variety of diet-quality dimensions. Use of a single diet component, eg, percent of energy from fat, to assess diet quality can lead to substantial misclas-sification. One reason for this misclassification is illustrated by comparing DQI scores to percent of energy from fat for individuals who consume alcohol or soft drinks. Alcohol tends to reduce nutrient density of the diet 24., 25., 26., 27.

APPLICATIONS

The Diet Quality Index was developed using scientifically sound diet recommendations and following a commonsense principle that every diet counselor knows: the sum total of food consumption behaviors makes a diet good or bad. This index is a real-world instrument because people consume a full set of foods and not isolated nutrients. It is also a measure of dietary risk for chronic diseases that are not caused or cured by one nutrient or food but by the overall dietary pattern.

It is commonly

Food and nutrition guidelines for New Zealand

A National Nutrition Taskforce was formed by the New Zealand Department of Health in September 1988. One of its charges was to review the “Nutrition Guidelines for New Zealanders.”

The Taskforce decided that the Food and Nutrition Guidelines should be written in terms of foods rather than nutrients. The final version of the guidleines they developed follows. The source was the Journal of the New Zealand Dietetic Association (1991;45:7–10)

  • Eat a variety of foods from the four major food groups

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  • Cited by (0)

    This study was funded, in part, by an American Dietetic Association Foundation Kraft General Foods Fellowship.

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