Indexes of Overall Diet Quality: A Review

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Abstract

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.

Section snippets

Indexes of Overall Diet Quality Based on Nutrients

Nutrient-based indexes of overall diet quality that reflect adequacy of nutrient intake have used either summary measures derived from a group of nutrients or single nutrients as indicators of intake of several nutrients (Table 1).

Indexes of Overall Diet Quality Based on Foods or Food Groups

Several investigators have examined intake patterns of food or food groups to identify patterns associated with nutrient adequacy. Their work is summarized in Table 2 The two primary approaches have been to develop scores derived from consumption of all foods or of foods grouped into major or minor groups, and to derive patterns by means of factor analyses on food groups.

Early attempts at classifying foods or food groups were conducted in response to the need for developing short-cut methods,

Indexes of Overall Diet Quality Based on Nutrients and Foods

Patterson et al (67) developed a diet quality index based on weighting of selected nutrient and food intake recommendations of the Food and Nutrition Board (1). (See Table 3.) This index successfully identified persons with high-quality diets based on the ability to meet nutrient needs and to decrease the intake of total and saturated fats.

The healthy eating index (HEI) developed by the US Department of Agriculture (68) consists of scores for consumption of the suggested number of servings of

Directions for Future Research

For epidemiologic studies of the relation of diet and disease, measuring overall diet quality should be considered an alternative that deals with multicollinearity of various dietary variables. Food-based indexes of diet quality are promising because these indexes retain the complexity of foods and permit an indirect assessment of nonnutrient constituents without reducing the assessment to a single nutrient or groups of nutrients.

Virtually no information on estimates of variability

Applications

Dietetics practitioners may find the indexes reviewed here useful for assessing overall diet quality. The particular index chosen depends on the needs of the population to be assessed, the dietary measurement method used, and the resources available for analysis of dietary data. ■

I thank Arthur Schatzkin, MD, DrPH, National Cancer Institute, and Marion Nestle, PhD, MPH, New York University, for their insightful comments on an earlier version of this review. I also thank the reviewers of this

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