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Norde MM, Bromage S, Marchioni DML, Vasques AC, Deitchler M, Arsenaut J, de Carvalho AM, Velloso L, Willett W, Giovannucci E, Geloneze B. The global diet quality score as an indicator of adequate nutrient intake and dietary quality - a nation-wide representative study. Nutr J 2024; 23:42. [PMID: 38627669 PMCID: PMC11022474 DOI: 10.1186/s12937-024-00949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective was to investigate the performance of GDQS as an indicator of adequate nutrient intake and dietary quality in a national-representative sample of the Brazilian population. METHODS Nationally-representative data from 44,744 men and non-pregnant and non-lactating women aging ≥ 10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-h recalls (24HR). The GDQS was calculated and compared to a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women-MDD-W) and to an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods-UPF). To estimate the odds for overall nutrient inadequacy across MDD-W and GDQS quintiles, a multiple logistic regression was applied, and the two metrics' performances were compared using Wald's post-test. RESULTS The mean GDQS for Brazilians was 14.5 (0-49 possible range), and only 1% of the population had a low-risk diet (GDQS ≥ 23). The GDQS mean was higher in women, elderly individuals and in higher-income households. An inverse correlation was found between the GDQS and UPF (rho (95% CI) = -0.20(-0.21;-0.19)). The odds for nutrient inadequacy were lower as quintiles of GDQS and MDD-W were higher (p-trend < 0.001), and MDD-W had a slightly better performance than GDQS (p-diff < 0.001). Having a low-risk GDQS (≥ 23) lowered the odds for nutrient inadequacy by 74% (95% CI:63%-81%). CONCLUSION The GDQS is a good indicator of overall nutrient adequacy, and correlates well with UPF in a nationally representative sample of Brazil. Future studies must investigate the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks.
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Affiliation(s)
- Marina M Norde
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil.
| | - Sabri Bromage
- Institute of Nutrition, Mahidol University, Phuttamonton, Thailand
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Dirce M L Marchioni
- Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Carolina Vasques
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
- School of Applied Sciences, University of Campinas, Limeira, SP, Brazil
| | - Megan Deitchler
- Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA
| | - Joanne Arsenaut
- Intake-Center for Dietary Assessment, FHI 360, Washington, DC, USA
| | - Aline M de Carvalho
- Department of Nutrition, School of Public Health of the University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Lício Velloso
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
| | - Walter Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Bruno Geloneze
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, SP, Brazil
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Liu Z, Zhao D, Dai S, Liang Y, Zhao M, Liu M, Zhong Z, Liang L, Tian Z, Yang Y. Inverse Association between the Global Diet Quality Score and New-Onset Hypertension in Adults: A Nationwide Cohort Study. J Nutr 2024; 154:1252-1261. [PMID: 38360116 DOI: 10.1016/j.tjnut.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) is a simple and practical dietary metric associated with a number of chronic diseases. The GDQS included various foods related to blood pressure, especially diverse plant-based foods that have shown to lower blood pressure. However, studies on the role of the GDQS in reducing the risk of new-onset hypertension and whether its performance differs from that of other dietary metrics are lacking. OBJECTIVE We aimed to examine the association between the GDQS and new-onset hypertension and to compare its performance with that of other dietary patterns, including the Plant-based Diet Index (PDI), alternate Mediterranean diet (aMED) score, Alternative Healthy Eating Index-2010, and Dietary Approaches to Stop Hypertension (DASH) score in Chinese adults. METHODS We included a total of 12,002 participants (5644 males and 6358 females) aged >18 y from the China Health and Nutrition Survey (1997-2015). Dietary intake was estimated using average food intakes from 3 consecutive 24-h dietary recalls. Multivariable relative risks (RRs) were computed for hypertension using modified Poisson regression models. RESULTS With ≤18 y of follow-up (mean 8.7± 5.4 y), we ascertained 4232 incident cases of hypertension. Compared with participants with a low GDQS score (<15), the multivariable-adjusted RR of hypertension was 0.72 [95% confidence interval (CI): 0.62, 0.83] among participants with a high score (≥23). A 25% increment in the GDQS was associated with a 30% (RR, 0.70; 95% CI: 0.64, 0.76) lower risk of new-onset hypertension, which was comparable with the RRs of new-onset hypertension associated with every 25% increment in the PDI (RR, 0.84; 95% CI: 0.76, 0.93), DASH score (RR, 0.84; 95% CI: 0.78, 0.91), and aMED score (RR, 0.89; 95% CI: 0.84, 0.93). CONCLUSION A higher GDQS was associated with a lower risk of new-onset hypertension, with comparable associations of new-onset hypertension with PDI, DASH, and aMED scores in Chinese adults.
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Affiliation(s)
- Zhihao Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Dan Zhao
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Suming Dai
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Ying Liang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Mingzhu Zhao
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Meitong Liu
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zepei Zhong
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Lihan Liang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zezhong Tian
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
| | - Yan Yang
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Guangdong Engineering Technology Center of Nutrition Transformation, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
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Bromage S, Pongcharoen T, Prachansuwan A, Sukboon P, Srichan W, Purttiponthanee S, Deitchler M, Moursi M, Arsenault J, Ali NB, Batis C, Fawzi WW, Winichagoon P, Willett WC, Kriengsinyos W. Performance of the Global Diet Quality Score (GDQS) App in Predicting Nutrient Adequacy and Metabolic Risk Factors among Thai Adults. J Nutr 2023; 153:3576-3594. [PMID: 37844842 PMCID: PMC10739769 DOI: 10.1016/j.tjnut.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related noncommunicable disease risk in diverse populations. A software application (GDQS app) was recently developed for the standardized collection of GDQS data. The application involves a simplified 24-h dietary recall (24HR) where foods are matched to GDQS-food groups using an onboard database, portion sizes are estimated at the food group level using cubic models, and the GDQS is computed. OBJECTIVES The study aimed to estimate associations between GDQS scores collected using the GDQS app and nutrient adequacy and metabolic risks. METHODS In this cross-sectional study of 600 Thai males and nonpregnant/nonlactating females (40-60 y), we collected 2 d of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between application scores and outcomes were estimated using multiple regression, and application performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity-Women, Alternative Healthy Eating Index-2010, and Global Dietary Recommendations score. RESULTS In covariate-adjusted models, application scores were significantly (P < 0.05) associated with higher energy-adjusted mean micronutrient adequacy computed using 24HR (range in estimated mean adequacy between score quintiles 1 and 5: 36.3%-44.5%) and FFQ (Q1-Q5: 40.6%-44.2%), and probability of protein adequacy from 24HR (Q1-Q5: 63%-72.5%). Application scores were inversely associated with BMI kg/m2 (Q1-Q5: 26.3-24.9), body fat percentage (Q1-Q5: 31.7%-29.1%), diastolic blood pressure (Q1-Q5: 84-81 mm Hg), and a locally-developed sodium intake score (Q1-Q5: 27.5-24.0 points out of 100); positively associated with high-density lipoprotein cholesterol (Q1-Q5: 49-53 mg/dL) and 24-h urinary potassium (Q1-Q5: 1385-1646 mg); and inversely associated with high midupper arm circumference (Q5/Q1 odds ratio: 0.52) and abdominal obesity (Q5/Q1 odds ratio: 0.51). Significant associations for the application outnumbered those for metrics computed using 24HR or FFQ. CONCLUSIONS The GDQS app effectively assesses nutrient adequacy and metabolic risk in population surveys.
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Affiliation(s)
- Sabri Bromage
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand; Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tippawan Pongcharoen
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.
| | - Aree Prachansuwan
- Human Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Pornpan Sukboon
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Weerachat Srichan
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Sasiumphai Purttiponthanee
- Research and Innovation Service Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | | | - Mourad Moursi
- Intake Center for Dietary Assessment, Washington, DC, USA
| | | | - Nazia Binte Ali
- Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carolina Batis
- Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Morelos, México
| | - Wafaie W Fawzi
- Department of Global Health and Populations, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Pattanee Winichagoon
- Community Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wantanee Kriengsinyos
- Human Nutrition Unit, Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.
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Restrepo-Mesa SL, Correa Guzmán N, Calvo V, Giraldo Quijano MC, Hernández Álvarez C, Bergeron G. Effect of an action-research nutrition intervention on the Global Diet Quality Score of Colombian adolescents. Ann N Y Acad Sci 2023; 1528:85-94. [PMID: 37772982 DOI: 10.1111/nyas.15068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Strategies to address the nutritional needs of adolescent girls and young women often focus on supplementation. In this study, an action-research approach involving a nutrition education and entrepreneurship intervention was carried out among adolescent girls and young women in poor neighborhoods of Medellín, Colombia. The intervention group significantly increased its intake of several nutrients, including energy, protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, dietary fiber, calcium, zinc, and vitamins A, B2, B3, B9, and C. A significant increase was observed in the intake of the Global Diet Quality Score (GDQS) healthy food groups (other fruits, other vegetables, legumes, high-fat dairy products), accompanied by a decrease in the consumption of some unhealthy food groups (sweets and ice creams). A multivariate regression controlling for age, socioeconomic status, occupation, Household Hunger Scale, mean probability of adequacy, physical activity, and body self-perception showed that the nutrition intervention improved the total GDQS by 33% in the intervention group-a substantial improvement notwithstanding the study group's precarious social and economic conditions. We conclude that nutrition education and entrepreneurship models based on this approach may improve the dietary profile of this population and reduce future pressures from nutrition-related chronic diseases.
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Affiliation(s)
- Sandra L Restrepo-Mesa
- Food and Human Nutrition Research Group, School of Nutrition and Dietetics, University of Antioquia, Antioquia, Colombia
| | - Nathalia Correa Guzmán
- Food and Human Nutrition Research Group, School of Nutrition and Dietetics, University of Antioquia, Antioquia, Colombia
| | - Víctor Calvo
- Food and Human Nutrition Research Group, School of Nutrition and Dietetics, University of Antioquia, Antioquia, Colombia
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Nguyen PH, Tran LM, Hoang NT, Deitchler M, Moursi M, Bergeron G. The Global Diet Quality Score is associated with nutrient adequacy and depression among Vietnamese youths. Ann N Y Acad Sci 2023; 1528:48-57. [PMID: 37566812 DOI: 10.1111/nyas.15053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
The Global Diet Quality Score (GDQS) has been recommended as a simple diet quality metric that is reflective of both nutrient adequacy and noncommunicable disease outcomes. It has been validated among women of reproductive age (15-49 years) in diverse settings but not specifically among younger women. This paper examines the relationship between the GDQS and nutrient adequacy, anthropometric outcomes, and depressive symptoms among 1001 Vietnamese young women aged 16-22 years. In energy-adjusted models, the GDQS was significantly (p < 0.05) and positively correlated with intakes of protein (ρ = 0.23), total fat (ρ = 0.06), nine micronutrients (calcium, iron, zinc, vitamin C, riboflavin, niacin, vitamin B6, folate, and vitamin A) (ρ = 0.12-0.35), and the mean probability of adequacy of micronutrients (ρ = 0.28). Compared to young women with optimal GDQS, those with low and very low GDQS were two to five times more likely to have a mean probability of nutrient adequacy less than 50% and showed two to three times higher odds for depression. No association was observed for GDQS and anthropometric outcomes. In conclusion, the GDQS performed well in capturing nutrient adequacy and depressive symptoms among Vietnamese young women. Further research is warranted to explore the relationship between diet quality and depression in other settings.
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Affiliation(s)
- Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, DC, USA
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | | | | | | | - Mourad Moursi
- Intake - Center for Dietary Assessment, Washington, DC, USA
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Gandham A, Scott D, Bonham MP, Kulkarni B, Kinra S, Ebeling PR, Zengin A. Sex Differences in Bone Health Among Indian Older Adults with Obesity, Sarcopenia, and Sarcopenic Obesity. Calcif Tissue Int 2022; 111:152-161. [PMID: 35507092 PMCID: PMC9300534 DOI: 10.1007/s00223-022-00981-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
Abstract
Age-related changes in fat and lean mass contribute to bone health, but these associations may be influenced by sex and ethnicity. This study investigated sex-specific associations of obesity and sarcopenia with bone mineral density (BMD) and bone mineral apparent density (BMAD) among Indian older adults. 1057 adults aged ≥ 50 years were included. Dual-energy X-ray absorptiometry (DXA) measured BMD at the hip, spine and whole-body, and BMAD was calculated as BMD/√bone area. Obesity was defined by body fat percentage (cut points; > 25% for men and > 35% for women), and sarcopenia was defined using the revised Asian Working Group for Sarcopenia classification with low hand grip strength (< 28 kg for men and < 18 kg for women) and appendicular lean mass index (< 7.0 kg/m2 for men and < 5.4 kg/m2 for women). Participants were classified into four groups: controls (no obesity or sarcopenia), obesity, sarcopenia, or sarcopenic obesity. Linear regression (β-coefficients and 95%CI) analyses were performed with adjustments for age, smoking status, protein intake, and socioeconomic status. Prevalence of sarcopenia (37%) and sarcopenic obesity (6%) were higher in men than women (17% and 4%, respectively). Compared with controls, men with obesity had lower whole-body BMD and BMAD, but women with obesity had higher hip and spine BMD and BMAD (all p < 0.05). Men, but not women, with sarcopenic obesity, had lower hip and whole-body BMD and BMAD (all p < 0.05) than controls. Men with sarcopenia had lower BMD and BMAD at the hip only, whereas women had lower BMD at all three sites and had lower BMAD at the hip and spine (all p < 0.05), compared with controls. Obesity, sarcopenia, and sarcopenic obesity have sex-specific associations with BMD and BMAD in Indian older adults. With the aging population in India, it is important to understand how body composition contributes to poor bone health among older adults.
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Affiliation(s)
- Anoohya Gandham
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Bharati Kulkarni
- Clinical Division, National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
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Bromage S, Batis C, Bhupathiraju SN, Fawzi WW, Fung TT, Li Y, Deitchler M, Angulo E, Birk N, Castellanos-Gutiérrez A, He Y, Fang Y, Matsuzaki M, Zhang Y, Moursi M, Kronsteiner-Gicevic S, Holmes MD, Isanaka S, Kinra S, Sachs SE, Stampfer MJ, Stern D, Willett WC. Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS). J Nutr 2021; 151:75S-92S. [PMID: 34689200 PMCID: PMC8542096 DOI: 10.1093/jn/nxab244] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.
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Affiliation(s)
| | | | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Megan Deitchler
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Erick Angulo
- National Institute of Public Health, Cuernavaca, Mexico
| | - Nick Birk
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yuna He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuehui Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mika Matsuzaki
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mourad Moursi
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Selma Kronsteiner-Gicevic
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,London Centre for Integrative Research on Agriculture and Health, London, United Kingdom
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sheila Isanaka
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sanjay Kinra
- London School of Hygiene and Tropical Disease, London, United Kingdom
| | - Sonia E Sachs
- Center for Sustainable Development, Columbia University, New York, NY, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Dalia Stern
- National Institute of Public Health, Cuernavaca, Mexico
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
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8
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Bromage S, Andersen CT, Tadesse AW, Passarelli S, Hemler EC, Fekadu H, Sudfeld CR, Worku A, Berhane H, Batis C, Bhupathiraju SN, Fung TT, Li Y, Stampfer MJ, Deitchler M, Willett WC, Fawzi WW. The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults. J Nutr 2021; 151:130S-142S. [PMID: 34689198 PMCID: PMC8564694 DOI: 10.1093/jn/nxab264] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/18/2021] [Accepted: 07/20/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. OBJECTIVES To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. METHODS We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. RESULTS In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia. CONCLUSIONS The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS' performance in capturing NCD outcomes in sub-Saharan Africa.
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Affiliation(s)
| | | | - Amare W Tadesse
- London School of Hygiene and Tropical Medicine, London, UK,Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | | | - Elena C Hemler
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hanna Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Megan Deitchler
- Intake–Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Bromage S, Zhang Y, Holmes MD, Sachs SE, Fanzo J, Remans R, Sachs JD, Batis C, Bhupathiraju SN, Fung TT, Li Y, Stampfer MJ, Deitchler M, Willett WC, Fawzi WW. The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries. J Nutr 2021; 151:119S-129S. [PMID: 34689197 PMCID: PMC8542095 DOI: 10.1093/jn/nxab161] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. OBJECTIVES We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. METHODS We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. RESULTS Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive. CONCLUSIONS The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.
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Affiliation(s)
- Sabri Bromage
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yiwen Zhang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michelle D Holmes
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Sonia E Sachs
- The Earth Institute, Columbia University, New York, NY, USA
| | - Jessica Fanzo
- Berman Institute of Bioethics, Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | - Roseline Remans
- The Alliance of Biodiversity International and the International Center for Tropical Agriculture (CIAT), Geneva, Switzerland
| | | | - Carolina Batis
- CONACYT—Health and Nutrition Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Shilpa N Bhupathiraju
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Teresa T Fung
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Simmons University, Boston, MA, USA
| | - Yanping Li
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Megan Deitchler
- Intake – Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Walter C Willett
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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