Diet Quality among the Brazilian Population and Associated Socioeconomic and Demographic Factors: Analysis from the National Dietary Survey 2008-2009

Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus

OBJECTIVE

The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM).

METHODOLOGY

Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and Tucker‒Lewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels.

RESULTS

A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05).

CONCLUSION

When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.

High diet quality indices associated with lower risk of lipid profile abnormalities in Taiwanese kidney transplant recipients

Cardiovascular disease (CVD) and its risk factors seem to be linked with deteriorated graft function and persists as the major cause of mortality in kidney transplant recipients (KTRs). Diet quality is associated with CVD prevention in the healthy population, however, less study focuses on KTRs. The study aimed to determine the association between diet quality indices and lipid profile abnormalities as risk factors for CVD in KTRs. This prospective study enrolled 106 KTRs who had functioning allografts from September 2016. Lipid profiles included low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) and were based on the National Cholesterol Education Program Adult Treatment Panel III recommendations. Three-day dietary data were collected by a well-trained registered dietitian. The Alternative Healthy Eating Index-Taiwan (AHEI-Taiwan), Alternative Healthy Eating Index-2010 (AHEI-2010), and Healthy Eating Index-2015 (HEI-2015) scores were calculated and divided into quartiles and compared accordingly. KTRs' mean LDL-C, HDL-C, TC, and TG levels were 119.8 ± 36.6 mg/dL, 52.0 ± 17.9 mg/dL, 205.8 ± 43.9 mg/dL, and 160.2 ± 121.6 mg/dL, respectively. Compared with the lowest quartile, only the highest quartile of AHEI-Taiwan had lower TC and LDL-C levels. After adjustment for age, gender, energy, Charlson comorbidity index, transplant duration, and dialysis duration, logistic regression analysis revealed that the highest quartile of AHEI-Taiwan had 82% (odds ratio [OR], 0.18; 95% confidence interval [CI] 0.04-0.72, p < 0.05) lower odds of high TC and 88% (OR 0.12; 95% CI 0.03-0.58, p < 0.05) lower odds of high LDL-C, and the highest quartile of HEI-2015 had 77% (OR 0.23; 95% CI 0.05-0.95, p < 0.05) lower odds of high LDL-C. Higher adherence to a healthy diet as per AHEI-Taiwan and HEI-2015 guidelines associated with lower risk of lipid profile abnormalities in KTRs.

Does mindful eating affect the diet quality of adults?

OBJECTIVES

This study aimed to examine the relationship between mindful eating and diet quality among adults in Turkey.

METHODS

A total of 207 adults, 138 women (66.7% of 207) and 69 men (33.3%), participated. This cross-sectional survey was carried out among adults aged 20-50 y. The following data were collected from face-to-face interviews: sociodemographic variables, health information, nutritional habits, anthropometric measurements, 24-h dietary records, and scores from the Mindful Eating Questionnaire (MEQ), Mediterranean Diet Adherence Screener (MEDAS), and Healthy Eating Index-2015 (HEI-2015).

RESULTS

The mean MEDAS scores of females were higher than those of males (P = 0.012). The mean HEI-2015 scores did not significantly differ between females and males (P > 0.05). The mean scores of the MEQ (P = 0.024) and its disinhibition (P = 0.005) and emotional eating (P = 0.000) subfactors were higher in males than in females. The MEQ mean score was negatively associated with daily energy (P = 0.038), carbohydrate (P = 0.046), and fat intake (P = 0.036). As the MEQ mean score increased, the greens and beans score (P = 0.009) and dairy intake score (P = 0.031) increased. A positive correlation was present between the eating discipline subfactor of the MEQ score and both the HEI-2015 (P = 0.002) and MEDAS mean scores (P = 0.001). However, no significant correlation was found between the mean MEQ and HEI-2015 scores and the MEDAS mean scores (P > 0.05).

CONCLUSIONS

Developing mindful eating might be helpful for individual health promotion and quality of life by providing improvements in diet quality of adults.

Dietary diversity indices v. dietary guideline-based indices and their associations with non-communicable diseases, overweight and energy intake: evidence from China

OBJECTIVES

To evaluate various diet quality indices and to estimate their associations with major non-communicable diseases (NCD) (i.e. diabetes mellitus (DM) and myocardial infarction (MI)) and risk for overweight (OW).

DESIGN

Four dietary diversity indices (namely, count index (Count), dietary diversity score index, berry index (BI) and entropy index (EI)) and three Chinese dietary guideline-based indices (namely, China healthy diet index, Chinese food pagoda score and diet quality divergence index) were employed to evaluate Chinese diet quality. DM, MI and OW were used as diet-related health indicators. Logit regressions were employed to unveil the associations between diet quality indices and NCD and risk for OW. The relationships between diet quality indices and daily energy intakes were checked with ordinary least squares linear regressions.

SETTING

Four recent waves (2004, 2006, 2009, 2011) of longitudinal individual data from China Health and Nutrition Survey.

PARTICIPANTS

Chinese adults (aged 18-64 years) from twelve provinces were included in the analysis (n 30 350).

RESULTS

Count, BI, and EI were positively associated with higher OW risk and daily energy intakes. As dietary guideline-based indices got better, people were exposed to lower DM and OW risks and got lower daily energy intakes. Finally, dietary guideline-based indices properly revealed the expected relationships that high-quality diets would reduce NCD and risk for OW, while high diversity indices were usually correlated with over-nutrition and high risks.

CONCLUSIONS

Increasing diversity of the diet does not necessarily improve the nutrition and health. Dietary guideline-based indices are more robust than dietary diversity indices; thus, they should be highly recommended when evaluating diet quality.

Diet quality as assessed by Healthy Eating Index-2015 among Hungarian Roma living in settlements of Northeast Hungary

Inequalities in diet quality are increasingly reported, but such studies among Roma are scarce and challenging. Here we attempt to examine diet quality and adherence to food based dietary guidelines among Hungarian Roma (HR) ethnic minority living in segregated settlements while comparing a sample of Hungarian adults from the general population (HG). Data were obtained from a complex comparative health survey conducted in Northeast Hungary in 2018, including sociodemographic and physical examination data. Dietary data were collected using two non-consecutive 24-h dietary recalls. We assessed diet quality based on using a 13-component Healthy Eating Index-2015 (HEI-2015, range 0-100). Differences in median intakes of food and nutrients and HEI-2015 scores were evaluated by Mann-Whitney test or Kruskal-Wallis test. Quantile regression was used to adjust HEI-2015 scores for socioeconomic factors including age, sex, educational status, and perceived financial status. This analysis included 393 and 415 subjects, aged between 18 to 70 years, of HR and HG populations, respectively. Results showed overall low median HEI-2015 scores for both HR and HG, with significantly lower total score among HR participants (41.6, interquartile range (IQR): 39.5-42.8) compared to HG (47.2, IQR: 45.7-51.1). Scores for individual components, such as intake of fruits, greens and beans, whole grains, seafood, and plant proteins were particularly suboptimal among both groups, but significantly lower among the HR population. Scores for refined grains, sodium, saturated fats and added sugar reflected high intakes of these components but did not differ between study groups. Our findings revealed an unfavorable diet quality among the HR compared to HG and a potentially increased risk for diet-related NCDs. Future health intervention programs are warranted to address dietary disparities of segregated minorities in Hungary while considering ethnic and cultural differences.

Metabolic Syndrome Is Associated with Low Diet Quality Assessed by the Healthy Eating Index-2015 (HEI-2015) and Low Concentrations of High-Density Lipoprotein Cholesterol

Presenting diet quality of patients with metabolic syndrome (MetS), using a holistic approach is more useful than investigating dietary individual components, but there is still a small amount of research in this area. The aim of this study assessed the diet quality, as measured by the HEI-2015, of MetS patients compared to healthy individuals. The study and control group consisted of 215 patients with MetS and 320 people without MetS, respectively. A nutritional analysis using a semi-quantitative food frequency questionnaire was used to evaluate the nutritional habits in the study and control group. Total HEI-2015 scores were significantly lower in MetS subjects than in those in the control group (65.04 ± 9.71 vs. 66.75 ± 8.88) and the quality of women’s diets was better than the quality of men’s diet (66.83 ± 8.99 vs. 64.75 ± 9.57). We also observed that low HDL-c concentration increased the risk of MetS in the general population the most. Across the population, there was a weak positive correlation between HDL-c concentrations and total HEI-2015 scores and a weak negative correlation between mean waist circumference values and total HEI-2015 scores. HDL-c concentrations may be a key factor in the prevention of MetS and appropriate therapeutic management to increase HDL-c levels may be of key importance in patients diagnosed with MetS.

Application of a Modified Healthy Eating Index (HEI-Flex) to Compare the Diet Quality of Flexitarians, Vegans and Omnivores in Germany

Interest in plant-based nutrition has steadily increased in the western world in the recent years. The number of people following a meat-reduced, flexitarian diet is growing continuously. However, little is known about the diet quality of flexitarians compared to vegans or omnivores. Therefore, in this cross-sectional study, the food intake of 94 participants aged between 25–45 years was recorded via a validated food frequency questionnaire and 28 self-designed questions about the consumption of plant-based alternatives. An adapted Healthy Eating Index, HEI-flex, was developed to evaluate the diet quality of flexitarians, vegans and omnivores. Higher score points (SP) of the HEI-flex are associated with higher compliance with the official diet recommendations (V_max = 100 SP). Finally, flexitarians scored significantly more highly when compared to omnivores (54 ± 8 vs. 47 ± 9 SP; p = 0.008) but lower than vegans (54 ± 8 vs. 61 ± 10 SP; p = 0.010). The results showed that the HEI-flex is a useful tool for assessing and comparing the diet quality of flexitarians, vegans and omnivores. Despite the consumption of highly processed plant-based alternatives, reduction in meat and meat products seems to be accompanied by increased overall diet quality.

Diet quality among older adults: What the Index Associated with the Digital Food Guide and the Brazilian Healthy Eating Index-Revised Reveal

The aim of the present study was to compare the Diet Quality Index-Digital Food Guide (DQI-DFG) to a more widely used measure in the literature: the Brazilian Healthy Eating Index-Revised (BHEI-R). A cross-sectional population-based study was conducted with 822 older adults (≥ 60 years) from the city of Campinas/SP, Brazil. The BHEI-R resulted in a higher overall score compared to DQI-DFG (62.9 vs. 47.7). For the BHEI-R, mean scores increased with age and were worse among smokers and individuals with a higher level of schooling. Regarding the DQI-DFG scores, no significant associations with age, schooling or smoking were detected; however, scores were higher in higher income segments. The components with the worst scores were whole grains, sodium and milk (BHEI-R); fruits, whole grains, roots/tubers, milk, refined cereals and red meat/processed (DQI-DFG). Divergences were found in the global scores and components of the indicators, reflecting important methodological differences. Studies of this nature constitute an opportunity to increase awareness regarding indicators of particular aspects of diet.

Low Adherence to the EAT-Lancet Sustainable Reference Diet in the Brazilian Population: Findings from the National Dietary Survey 2017–2018

Diets are simultaneously connected with population health and environment. The EAT-Lancet Commission proposed a sustainable reference diet to improve population health and respect the planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) has been developed to assess the adherence to this reference diet. In the present study, we aimed to evaluate the adherence to the EAT-Lancet diet through the PHDI in a nationwide population-based study carried out in Brazil. We used data from the National Dietary Survey conducted through the Household Budget Survey in 2017–2018, with 46,164 Brazilians aged over 10 years old. Food consumption was evaluated with a 24 h dietary recall. The average PHDI total score in the Brazilian population was 45.9 points (95% CI 45.6:46.1) on a total score that can range from 0 to 150 points. The adherence to EAT-Lancet diet was low among all Brazilian regions. Women, elderly, those overweighed/obese, with higher per capita income and living in the urban area had higher scores in the PHDI. In general, the Brazilian population presented low adherence to a healthy and sustainable dietary pattern and seems far from meeting the EAT-Lancet recommendations.

Active vegetarians show better lower limb strength and power than active omnivores

Vegetarian diets have become popular among athletes and active individuals and can have advantages for physical performance, but the results are still conflicting regarding muscle strength and power. The aim of this study was to evaluate the diet and physical performance of vegetarians through tests of dynamic, isometric, and relative strength; muscle power; and aerobic capacity. In this cross-sectional study, 32 vegetarians and 26 omnivores, who were physically active, were evaluated for the Healthy Eating Index and performance tested back squat, handgrip strength, isometric deadlift strength, jump with countermovement, and maximum aerobic speed (MAS). Improved diet quality (63.24 ± 14.40 vs. 54 ± 16.80, p<0.05), greater relative strength (1.03 ± 0.23 vs. 0.91 ± 0.12, p<0.05), and greater jump height (43.77 ± 9.91 vs. 38.45 ± 8.92, p<0.05) were found among vegetarians. No difference was seen in MAS (13.5 ± 2 vs. 11 ± 3, p>0.05) or isometric strength of upper limbs (77 ± 29 vs. 70 ± 50, p>0.05) and lower limbs (89 ± 41 vs. 97 ± 50, p>0.05). Thus, we conclude that vegetarians and omnivores show similar performance in strength and aerobic capacity, but in our sample, vegetarians show higher levels of relative strength and power.

Nutrient Intakes among Brazilian Children Need Improvement and Show Differences by Region and Socioeconomic Level

Brazil is the most populous country in South America. Using 24 h dietary data, we compared the nutrient intakes of 4–13-year-olds to reference values and tested for regional and socioeconomic (SES) differences. A considerable proportion reported intakes below the Estimated Average Requirements (EAR) for vitamins E (78.1%, 96.5%), D (100% for both), and calcium (80.5%, 97.7%) for 4–8 and 9–13-year-olds, respectively. Few exceeded Adequate Intakes (AI) for potassium or fiber. Older children reported greater inadequacies and, while there was regional variability, patterns of inadequacy and excess tended to be similar. For vitamin C, the percent of children below EAR in the Northeast and Southeast was lower than in the South. Most children, regardless of SES, had energy intakes within the Acceptable Macronutrient Distribution Ranges (AMDRs) for carbohydrates and protein. Over a quarter reported total energy from fat less than the AMDR, and inversely associated with SES (low 50.9%, moderate 26.0%, and high 15.0%), but also exceeding the percentage of energy recommendation for saturated fat, increasing with SES (low 18.1%, moderate 38.9%, and high 48.8%). The contrast observed between the diets of young Brazilians and recommendations underscores the need for individual and regional environmental interventions to promote healthier dietary patterns.

The quality and inflammatory index of the diet of patients with migraine

BACKGROUND

The association between diet and migraine has been reported in the literature, but only a few studies have evaluated whether the diet consumed by patients with migraine differs from individuals without migraine.

OBJECTIVE

Herein, we aimed to investigate whether the quality and the Dietary Inflammatory Index (DII) of diet consumed by migraine patients differ from that consumed by healthy controls. We also evaluated whether the severity of migraine and headache frequency were associated with these parameters.

METHODS

Patients of both sexes, aged between 18 and 65, with episodic migraine and healthy controls were enrolled in this cross-sectional study. Disability and impact caused by migraine and depressive symptoms were evaluated. Dietary intake was assessed using a 24-hour dietary recall and a three-day non-consecutive food record. The quality of the diet was calculated using the Healthy Eating Index (HEI)-2015 adapted to the Brazilian population, and DII was calculated based on the method developed by Shivappa et al. (2014).

RESULTS

Ninety patients with migraine and 62 individuals without migraine were included in this study. The groups did not differ regarding age, sex, marital status, years of schooling, anthropometric characteristics, and depressive symptoms. Patients with migraine had lower HEI total score than controls, indicating that these patients have a lower quality of the diet. Patients with migraine also had higher DII than controls. Nevertheless, HEI and DII scores did not correlate with migraine frequency and severity.

CONCLUSION

This study corroborates the view that the characteristics of the diet might be involved in migraine pathophysiology.

Diet Quality and Its Effect on Weight Gain Prevention in Young Adults: A Narrative Review

Global environmental and societal changes have resulted in an increased consumption of energy-dense foods contributing to escalating obesity prevalence, with most rapid weight gain occurring in young adults. Diet is one major modifiable factor contributing to escalating obesity prevalence. Understanding overall diet quality of populations at high risk for weight gain and obesity development, including young adults, provides evidence of dietary intakes, dietary patterns, and associated behaviors, to inform the development of targeted interventions aimed at the prevention of weight gain. This narrative review synthesizes the current evidence of the association between diet quality and weight gain in young adults. Overall, there is a consistent direction of association between improved diet quality and reduced weight gain in adults. This demonstrates the potential of small improvements in diet quality over time as a probable contributor to minimizing weight gain in young adults. Future research evaluating environmental nutrition policies with associated change in diet quality and prospective weight change in population-based studies is warranted to determine their longer-term impact in improving overall diet quality as one strategy to halt escalating obesity prevalence rates.

Digital food environment of a Brazilian metropolis: food availability and marketing strategies used by delivery apps

OBJECTIVE

Food delivery apps represent an important and emerging dimension of the digital food environment. This study aimed to examine food availability and the use of marketing strategies by two food delivery apps in a Brazilian metropolis.

DESIGN

An exploratory study was conducted in the city of Belo Horizonte, Minas Gerais. Food groups were identified and the use of price discounts and photos by the apps was observed.

SETTING

Eighteen neighbourhoods and the ten best rated restaurants in each app.

PARTICIPANTS

Three hundred sixty-two commercial food establishments.

RESULTS

The proportion of ultra-processed beverages on offer in the apps (78·45 %) was much higher in comparison with water (48·89 %), natural juices or smoothies (27·07 %). Ultra-processed ready-to-eat meals represented almost 70 % of the food offered in the establishments' menus, while traditional meals and vegetables represented just over 30 % of the offering. Ice cream, candies and salty packaged snacks were nine times more frequently presented than fruits. The use of photos and price discounts prevailed predominantly among ultra-processed beverages, sandwiches and ice cream, candies and salty packaged snacks. These marketing strategies were least used for promoting fruits and vegetables.

CONCLUSIONS

Restaurants registered on food delivery apps offered a significant amount of ultra-processed foods with price discounts and photos in comparison with unprocessed and minimally processed foods.

Dietary pattern and nutrient intakes in association with non-communicable disease risk factors among Filipino adults: a cross-sectional study

BACKGROUND

This study evaluated the relationship between dietary quality and food patterns of Filipino adults and the rising prevalence of selected cardiometabolic non-communicable disease (NCD) risk factors.

METHODS

This is a cross-sectional study that examined the association of dietary pattern and NCDs using data collected in the 2013 National Nutrition Survey. A total of 19,914 adults aged 20 years and above were included in the analyses. The Alternative Healthy Eating Index (AHEI-2010) was used to characterize the dietary quality, and principal component analysis (PCA) was used to identify dietary patterns specific to the study population. Logistic regression models were applied to assess the association between the dietary pattern scores and selected cardiometabolic NCD indices including diabetes, hypertension, dyslipidemia and overweight and obesity with adjustment for potential confounders.

RESULTS

The mean AHEI-2010 score was 19.7 for women and 18.9 for men out of a total possible score of 100. Three major dietary patterns were identified through PCA: 1) meat and sweetened beverages (MSB); 2) rice and fish (RF) and 3) fruit, vegetables and snack (FVS). After adjustment for potential confounding factors, the AHEI pattern was associated with higher odds of overweight/obesity [extreme-tertile odds ratio (OR) 1.10, 95% confidence interval (CI) 1.02-1.21]. Subjects in the highest tertile of the MSB pattern had greater odds for overweight/obesity, diabetes, high total cholesterol, low HDL-cholesterol, high LDL-cholesterol, and high triglycerides (OR ranging 1.20 to 1.70, all p-value < 0.001). The RF pattern was associated with higher probability of overweight/obesity (OR 1.20, 95% CI 1.08-1.32) high LDL-cholesterol (OR 1.20, 95% CI 1.07-1.37), and less likelihood of diabetes (OR 0.87, 95% CI 0.77-0.98). The FVS pattern was associated with lower probability of overweight/obesity, diabetes, high triglycerides, and hypertension (OR ranging 0.85 to 0.90, all p-value < 0.05).

CONCLUSIONS

Diet quality of Filipino adults is extremely poor. MSB and RF patterns were associated with a higher risk of cardiometabolic NCD indices, while FVS pattern was associated to lower risks. Identifying healthy and detrimental dietary patterns in the local diet could be informative for future local-based dietary recommendation and area-specific intervention programs.

Trends in the dietary patterns of Mexican adults by sociodemographic characteristics

Background

Sociodemographic characteristics are associated with the dietary patterns of populations. However, the direction of the association is not consistent among countries: it is contingent on the nutritional transition phase, level of economic development, cultural contexts and both the social and health policies prevailing in each country. The objective of this study was to identify the trends in dietary patterns observed in 2006, 2012 and 2016 among Mexican adults by sociodemographic characteristic.

Methods

To determine and compare dietary patterns, we performed a secondary analysis of dietary and sociodemographic data for adults 20–59 years old. Data were drawn from the 2006 and 2012 National Health and Nutrition Surveys (ENSANUTs) together with the 2016 Half-Way National Health and Nutrition Survey (ENSANUTMC). To estimate the dietary patterns, we used an adapted version of the Healthy Eating Index-2015 (HEI-2015) and a quantile-based regression model to compare the HEI medians by sociodemographic characteristic.

Results

From 2006 to 2016, the quality of the diet of Mexican adults scored under 50 points on a scale of 0 to 100, markedly below the maximum scores for the majority of HEI-2015 components. Diet quality varied according to age, sex, socioeconomic status (SES), area (urban/rural) and region of residence, with the highest quality observed among older individuals (within the 40–59 age group), women, people of lower SES and residents of rural areas, particularly in southern Mexico. Although this trend remained constant overall throughout 2006, 2012 and 2016, specific HEI-2015 components showed an opposite trend by sociodemographic strata.

Conclusion

The diet quality of Mexican adults was suboptimal from 2006 to 2016, with notorious disparities persisting over time among sociodemographic strata. Our results can serve as a basis for formulating recommendations on ways to improve the population diet, where those components diverging the most from adequate scores could be highlighted in public-health messages.

Dynamics of Chinese Diet Divergence from Chinese Food Pagoda and Its Association with Adiposity and Influential Factors: 2004-2011

Nutrition transition in China has a strong impact on dietary quality and health of Chinese consumers. This study developed the diet quality divergence Index (DQD), the divergence between real food consumption and the Chinese food pagoda 2016 (CFP), to measure the quality of diet in China. Using four waves of data (2004, 2006, 2009, and 2011) from China Health and Nutrition Survey (CHNS), this study shed light on the transition of diet quality for Chinese residents. Results indicate that the DQD generally decreased and Chinese diet quality improved during 2004-2011. The divergence was mainly caused by over-consumption of legumes and nuts, and under-consumption of milk and milk products. Rising income and urbanization were positively correlated with diet quality for the people with low DQD. However, both of them had negative impacts on diet quality for those with high DQD. Females and rural residents held a lower DQD than their counterparts. The results also revealed that healthy food preference, education, dining at home, household size, proportions of teens (6-17) and elders (over 64) in the families are positively correlated with Chinese diet quality. However, labor intensity, frequency of drinking alcohol, and smoking have negative impacts on diet quality. Moreover, higher DQD was found to be associated with increasing risks of overweight/obesity. Therefore, we suggest national healthy policies should pay more attention to nutrition education. It is also necessary to focus on populations with poor diet quality and to adopt measures to control drinking alcohol and smoking.