Greater dietary variety is associated with better biochemical nutritional status in Spanish children: the Four Provinces Study

Associations between dietary variety, portion size and body weight: prospective evidence from UK Biobank participants

'Dietary variety' has been identified as a factor associated with food intake. Whilst this relationship may have longer-term benefits for body weight management when eating low-energy, nutrient-dense foods, it may increase the risk of overconsumption (and body adiposity) when foods are high energy density. This study sought to further explore pathways underpinning the relationship between dietary variety and body weight, by considering energy density as a moderating factor and portion size as a mediating factor in this relationship. Using prospective data from the UK Biobank, dietary variety scores (DVS), cumulative portion size and energy density were derived from 24-h dietary recall questionnaires at baseline and follow-up. BMI, whole-body fat percentage and fat-free mass were included as outcomes. Contrary to predictions, linear multiple regression models found some evidence of a negative, direct association between DVS and body weight outcomes at baseline (b = -0·13). Though dietary variety was significantly associated with larger portions across time points (b = 41·86-82·64), a moderated mediation effect was not supported at baseline or follow-up (Index ≤ 0·035). Taken together, these findings provide population-level evidence to support a positive association between variety and food intake, which in turn has potential implications for body weight management, both in terms of moderating food intake and benefitting diet quality.

Adherence to Dietary Recommendations of 7-Year-Old Children from a Birth Cohort in Friuli Venezia Giulia, Italy

Few Italian and European studies have assessed adherence to dietary recommendations in primary school children using dietary records. No Italian studies have provided an index-based nutritional adequacy assessment. We provided a comprehensive overview of dietary intake in 381 7-year-old children from NAC-II cohort study, Friuli Venezia Giulia (Italy). Energy, macro-, and micronutrient intakes were derived from 3-day dietary records. Standard (median and percentage) and index-based (Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR)) approaches were used to evaluate adequacy to Italian dietary reference values at nutrient- and overall-diet-level. Percentage contribution of macronutrients to energy intake (%En) was unbalanced towards total fats and protein. In 25% of children, total fats intake exceeded the reference intake upper limit. In ~63% of children, protein intake was at least doubled in their child-specific population reference intake. Median intakes of sodium (1.7 g/day), saturated fatty acids (12.2 %En), and soluble carbohydrates (19.4 %En) exceeded the suggested dietary target in most (65–84%) children. Inadequacy was also observed for micronutrients, with median NARs ranging from 0.11 (vitamin D) to 0.90 (zinc). The median MAR was 0.75 (0.69–0.79), with 1 indicating optimal overall dietary intake. In conclusion, the enrolled children showed suboptimal intakes of several macro- and micronutrients, in line with Italian and European studies on primary school children. Based on the current findings, public health interventions may be targeted to specific nutrients or subpopulations.

Dietary diversities score and anthropometric characteristics in Iranian elementary school children

Dietary diversity scoring is a good method to assess quality of individual's diet. The study aimed to investigate the association between dietary diversity and body mass index among elementary school students in the south of Tehran, Iran. This cross-sectional study was conducted on elementary school students, age range of 7-12 years old, in 2015. Data were collected using a personal information questionnaire and three 24-h recall questionnaires. Dietary diversity score was calculated from the number of food groups in these questionnaires. A total of 536 students, 258 (48.1%) female and 278 (51.9%) male, were recruited in the study. The mean age of the students was 9.43 ± 1.73 years. Seafood consumption was more frequent and beans was lower frequent in students at higher BMI (≥95th percentile) than the other children (34% vs 25% and 71% vs 83%, respectively, p<0.05). However, the statistical analysis failed to find significant relationships between children’s body mass index (BMI) with consumption of diary, vegetable, fruits, protein, fat, and junk food intake. The association between children's BMI with seafood and beans consumption confirmed in multivariate analysis (OR= 1.50 and 0.52, respectively, p<0.05). The study finding showed that seafood and beans consumption may influence on elementary student BMI.

The Validity of Children's Fruit and Vegetable Intake Using Plasma Vitamins A, C, and E: The SAYCARE Study

Despite that fruits and vegetables are key elements for health promotion, there are limited studies validating their intake in children. We aimed to validate the SAYCARE (South American Youth/Child Cardiovascular and Environmental) Study Food Frequency Questionnaire (FFQ) and the combination of the FFQ frequency of intake with the 24 h-dietary-recall (24 h-DR) (mean of 3 days), for children's fruit and vegetable intake. The reference methods were plasma dosages of β-carotene, retinol, ascorbic acid, and α-tocopherol, which were collected in the school environment. It is a validity study in a subsample of 45 children aged 6-10 years participating in the SAYCARE Study, from São Paulo (Brazil). The FFQ was answered by the parents/guardians over the previous 3 months; the 24 h-DR was answered three times (two weekdays by nutritionists, one weekend day by parents/guardians). The mean fruit and vegetable intake (combined with frequency of intake) was calculated using the multiple source method (MSM). Multiple linear regression showed pooled correlation coefficients of 0.29 to 0.35 for the reported fruit and vegetable intake estimated by the FFQ and the MSM, respectively. The SAYCARE FFQ is an accurate and useful tool for ranking fruit and vegetable intake in children between 6-10 years from the SAYCARE Study.

Novel public-private partnerships to address the double burden of malnutrition

Public–private partnerships are an effective way to address the global double burden of malnutrition. While public–private partnerships operate in multiple forms, their leadership usually falls to governments, public health agencies, or nongovernmental organizations, with the private sector taking a subordinate role. The rapid ascent of social media and mass communications worldwide has provided a disruptive technology for new nutrition intervention programs. A new model, provisionally called private–public engagement, takes advantage of social media, mass media, and integrated social marketing to reach parents, families, and communities directly. These new private–public engagement initiatives need to be managed in ways suggested for public–private partnerships by the World Health Organization, especially if the private sector is in the lead. Once the rationale for engagement is defined, there is a need to mobilize resources, establish in-country partnerships and codes of conduct, and provide a plan for monitoring, evaluation, and accountability. Provided here is an example consistent with the private–public engagement approach, ie, the United for Healthier Kids program, which has been aimed at families with children aged less than 12 years. Materials to inspire behavioral change and promote healthier diets and lifestyle were disseminated in a number of countries through both digital and physical channels, often in partnership with local or regional governments. A description of this program, along with strategies to promote transparency and communication among stakeholders, serves to provide guidance for the development of future effective private–public engagements.

What is the Validity of Questionnaires Assessing Fruit and Vegetable Consumption in Children when Compared with Blood Biomarkers? A Meta-Analysis

Fruit and vegetable consumption has been associated with improved health outcomes in children. As an extensive number of questionnaires are currently used to assess fruit and vegetable consumption, we performed a systematic review of the criterion validity of questionnaires used to estimate fruit and vegetable consumption in children, considering blood biomarkers as the reference method. Five electronic databases (MEDLINE, CINAHL, Scopus, PsycINFO, Web of Science) were searched from database inception to 23 July 2018. The search strategy used the following sets of descriptors: children; fruits and vegetables; dietary questionnaires; blood biomarkers; and validation coefficient. The search terms were adapted for use with other databases in combination with database-specific filters. Potentially eligible articles were selected independently by two reviewers, separately, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two articles meeting the inclusion criteria were included. The main reason for study exclusion was the sample age range, which included adolescents. The pooled correlation coefficient was 0.32 (95% confidence interval: 0.24–0.40).This review provided insights into assessment methods of fruit and vegetable consumption in children. Although further studies are required, questionnaires for assessing fruit and vegetable consumption have fair criterion validity in children.

Review of a priori dietary quality indices in relation to their construction criteria

A multitude of indices measure the healthiness of dietary patterns. Because validation results with respect to health outcomes do not sufficiently facilitate the choice of a specific dietary quality index, the decision of which index to use for a particular research objective should be based on other criteria. This review aims to provide guidance on which criteria to focus upon when choosing a dietary index for a specific research question. A review of 57 existing specifications of dietary quality indices was conducted, taking explicitly into account relevant construction criteria explicated in the Organisation for Economic Co-operation and Development handbook on constructing composite indicators. Index construction choices regarding the following criteria were extracted: theoretical framework, indicator selection, normalization and valuation functions, and aggregation methods. Preferable features of dietary indices are discussed, and a summarizing toolbox is provided to help identify indices with the most appropriate construction features for the respective study aim and target region and with regard to the available database. Directions for future efforts in the specification of new diet quality indices are given.

A Comparison of the Nutrient Intakes of Macronutrient-Based Dieting and Strict Dieting Bodybuilders

The purpose of this study was to provide a descriptive assessment of the nutritional habits of competitive bodybuilders and compare the nutrient intakes of macronutrient-based dieting and strict dieting individuals. Data from 41 subjects (30 males and 11 females) were used in analyses. Participants completed a comprehensive food frequency questionnaire, and diets were analyzed using a computer system. Males consumed an average of 2,577.2 kcal (SD = 955.1), with an average fat intake of 83.6 g (SD = 41.3), an average carbohydrate intake of 323.3 g (SD = 105.2), and an average protein intake of 163.4 g (SD = 70.4). There were no significant differences between male macronutrient-based dieting and strict dieting bodybuilders when mean intakes were compared for all nutrients, including the macronutrients, selected vitamins and minerals, dietary fiber, added sugars, and saturated fat. Females in this study consumed an average of 1,794 kcal (SD = 453.1), with an average fat intake of 58.3 g (SD = 23.1), a mean carbohydrate intake of 217.8 g (SD = 85.9), and an average protein intake of 103.8 g (SD = 35.7). For females, macronutrient-based dieters consumed significantly greater amounts of several nutrients, including protein, vitamin E, vitamin K, and vitamin C. Over half of individuals from all groups consumed less than the recommended amounts of several of the micronutrients. Based on this information, it is recommended that competitive bodybuilders should be advised to take their micronutrition into greater consideration.

The relationship between diet quality and insulin resistance in obese children: adaptation of the Healthy Lifestyle-Diet Index in Turkey

BACKGROUND

Childhood obesity and its complications are serious health problems and diet/lifestyle changes can be beneficial for the prevention of diseases. Adaptation of the Healthy Lifestyle-Diet (HLD) Index in accordance with the dietary guidelines for Turkey (TR) and determination of the relationship between metabolic syndrome risk factors in obese children were the aims of this study.

METHODS

This study was conducted on 164 overweight or obese children (87 male, 77 female) aged 9-13 years. For all participants, the HLD-TR Index and a 24-h dietary recall were performed and the mean adequacy ratio (MAR) was calculated. Anthropometric measurements and the body composition of the children were taken. Metabolic syndrome risk factors and insulin resistance were assessed.

RESULTS

The mean age of the male and female children was 11.2±1.49 and 11.0±1.40 years, respectively. The majority of the children were obese in both genders. There were no statistically significant differences in the HLD-TR scores between the genders. As the index scores increased, a decrease in the energy intake and an increase in the MAR were observed. Negative correlations between the index scores and body mass, waist circumference and body fat mass were observed. Furthermore, a one-unit increase in the index score decreases the insulin resistance risk by 0.91 times after adjustments for age and gender (odds ratio: 0.91 [0.85-0.97]).

CONCLUSIONS

The HLD-TR Index is a valid tool that can give an idea about the quality of the diet in obese children. Furthermore, with the increase in the compliance with recommendations for diet/lifestyle changes, indicators of obesity and metabolic syndrome were decreased.

Understanding the Relationship Between Food Variety, Food Intake, and Energy Balance

PURPOSE OF REVIEW

In accordance with US dietary guidance, incorporating variety into the diet can align with energy balance, though greater food variety in some categories may make energy balance more challenging. Thus, experimental and epidemiologic evidence is summarized on the relationship between food variety, food and energy intake, and energy balance.

RECENT FINDINGS

Lab-based, experimental research consistently demonstrates that greater variety within foods or sensory characteristics of food increases food and energy intake within an eating occasion. Epidemiologic evidence is less consistent, potentially driven by differing methodologies, particularly in defining and measuring food variety. Moreover, the effect of variety on energy balance appears to be moderated by food energy density. Integrating insights from experimental and epidemiologic research are essential for strengthening food variety guidance including developing evidence-based definitions of food variety, understanding moderators of the relationship, and developing practical guidance interpretable to consumers.

Association of Dietary Variety and Diversity With Body Mass Index in US Preschool Children

BACKGROUND AND OBJECTIVES

Dietary variety and diversity are recommended in dietary guidelines, but their association with BMI in US preschool-aged children is unknown. This study examined predictors of dietary variety and diversity and their association with child BMI z score (BMIz).

METHODS

Primary caregivers responded to a food frequency questionnaire. Child anthropometry was obtained concurrently (n = 340) and prospectively (n = 264). Dietary variety scores and dietary diversity scores were computed. Multivariable linear regression was used to model predictors of these scores and their association with BMIz concurrently and BMIz change per year prospectively.

RESULTS

The sample was 49.4% boys; 69.4% of the primary caregivers were non-Hispanic white and 46.2% had a high school education or less. Girls and older children had greater Fruit and Vegetable Variety (gender: P = .03, age: P < .001), Healthy Foods Variety (P = .02, P < .001), and Dietary Diversity (P = .04, P = .03) scores. Older children also had greater scores for Overall Variety (P < .001) and Moderation Foods (eg, high-fat, high-sugar foods recommended to be consumed in moderation) (P < .001). Having a non-Hispanic white primary caregiver (versus not) was associated with lower Dietary Diversity (P = .01). Greater Healthy Variety, Overall Variety, and Dietary Diversity were associated with greater annual increases in BMIz prospectively (β[SE] = 0.009 [0.004], P = .04; β[SE] = 0.007 [0.003], P = .02; β[SE] = 0.003 [0.001], P = .02, respectively), adjusted for energy intake.

CONCLUSIONS

Greater dietary variety and diversity were prospectively associated with higher BMIz. Targeting dietary variety and diversity as an obesity prevention strategy in children requires careful consideration.

Development of a Dietary Index to Assess Overall Diet Quality for Chinese School-Aged Children: The Chinese Children Dietary Index

BACKGROUND

A composite measure of diet quality is preferable to an index of nutrients, food groups, or health-promoting behaviors in dietary assessment. However, to date, such a tool for Chinese children is lacking.

OBJECTIVE

Based on the current Chinese Dietary Guidelines and Dietary Reference Intakes, a dietary index for Chinese school-aged children, the Chinese Children Dietary Index was developed to assess overall diet quality among children in South China.

DESIGN

Dietary data were recorded using 24-hour recalls among 1,719 children aged 7 to 15 years between March and June 2013. Inactivity data and sociodemographic information were also collected. The Chinese Children Dietary Index included 16 components, which incorporated nutrients, foods/food groups, and health-promoting behaviors. The range of possible Chinese Children Dietary Index scores was 0 to 160, with a higher score indicating better diet quality.

STATISTICAL ANALYSIS PERFORMED

Pearson/Spearman correlation was used to assess relative validity using correlations between total Chinese Children Dietary Index score and age, body mass index (BMI; calculated as kg/m(2)), inactivity, whole-grain intake, frequency of fried-foods intake, nutrient adequacy ratios for energy intake and 12 nutrients not included in the Chinese Children Dietary Index, and the mean adequacy ratio. Finally, a stepwise multiple regression analysis was performed to indicate the factors correlated with Chinese Children Dietary Index.

RESULTS

Mean Chinese Children Dietary Index score of this sample was 88.1 points (range=34.2 to 137.8), the Chinese Children Dietary Index score of girls was higher than that of boys and decreased with higher age. Children with higher Chinese Children Dietary Index had lower body mass index and spent less time being inactive. Positive associations were observed between Chinese Children Dietary Index and the majority of nutrient adequacy ratios and the mean adequacy ratio. Age, paternal educational level, and family size were correlated with Chinese Children Dietary Index.

CONCLUSIONS

The Chinese Children Dietary Index successfully differentiated diets and, therefore, it can be used to rank-order overall diet quality among Chinese children. As the results showed, diet quality among Chinese children needs to be improved, especially in adolescents.

A dietary guideline adherence score is positively associated with dietary biomarkers but not lipid profile in healthy children

BACKGROUND

Whether dietary indexes are associated with biomarkers of children's dietary intake is unclear.

OBJECTIVE

The study aim was to examine the relations between diet quality and selected plasma biomarkers of dietary intake and serum lipid profile.

METHODS

The study sample consisted of 130 children aged 4-13 y (mean ± SD: 8.6 ± 2.9 y) derived by using baseline data from an intervention study. The Dietary Guideline Index for Children and Adolescents (DGI-CA) comprises the following 11 components with age-specific criteria: 5 core food groups, whole-grain bread, reduced-fat dairy foods, discretionary foods (nutrient poor; high in saturated fat, salt, and added sugar), healthy fats/oils, water, and diet variety (possible score of 100). A higher score reflects greater compliance with dietary guidelines. Venous blood was collected for measurements of serum lipids, fatty acid composition, plasma carotenoids, lutein, lycopene, and α-tocopherol. Linear regression was used to examine the relation between DGI-CA score (independent variable) and concentrations of biomarkers by using the log-transformed variable (outcome), controlling for confounders.

RESULTS

DGI-CA score was positively associated (P < 0.05) with plasma concentrations of lutein (standardized β = 0.17), α-carotene (standardized β = 0.28), β-carotene (standardized β = 0.26), and n-3 (ω-3) fatty acids (standardized β = 0.51) and inversely associated with plasma concentrations of lycopene (standardized β = -0.23) and stearic acid (18:0) (standardized β = -0.22). No association was observed between diet quality and α-tocopherol, n-6 fatty acids, or serum lipid profile (all P > 0.05).

CONCLUSION

Diet quality, conceptualized as adherence to national dietary guidelines, is cross-sectionally associated with plasma biomarkers of dietary exposure but not serum lipid profile. This trial was registered with the Australia New Zealand Clinical Trial Registry (www.anztr.org.au) as ACTRN12609000453280.

Validity of the Australian Recommended Food Score as a diet quality index for Pre-schoolers

BACKGROUND

Diet quality tools provide researchers with brief methods to assess the nutrient adequacy of usual dietary intake. This study describes the development and validation of a pediatric diet quality index, the Australian Recommended Food Scores for Pre-schoolers (ARFS-P), for use with children aged two to five years.

METHODS

The ARFS-P was derived from a 120-item food frequency questionnaire, with eight sub-scales, and was scored from zero to 73. Linear regressions were used to estimate the relationship between diet quality score and nutrient intakes, in 142 children (mean age 4 years) in rural localities in New South Wales, Australia.

RESULTS

Total ARFS-P and component scores were highly related to dietary intake of the majority of macronutrients and micronutrients including protein, β-carotene, vitamin C, vitamin A. Total ARFS-P was also positively related to total consumption of nutrient dense foods, such as fruits and vegetables, and negatively related to total consumption of discretionary choices, such as sugar sweetened drinks and packaged snacks.

CONCLUSION

ARFS-P is a valid measure that can be used to characterise nutrient intakes for children aged two to five years. Further research could assess the utility of the ARFS-P for monitoring of usual dietary intake over time or as part of clinical management.

Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents

BACKGROUND

Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide.

METHODS

Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years.

RESULTS

One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors.

CONCLUSIONS

The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.

Dietary and lifestyle quality indices with/without physical activity and markers of insulin resistance in European adolescents: the HELENA study

Emerging data indicate that higher levels of insulin resistance (IR) are common among children and adolescents and are related to cardiometabolic risk; therefore, IR requires consideration early in life. In addition, there is a lack of conclusive evidence regarding the role of dietary nutrients on IR. The Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) was conducted in European adolescents aged 12·5–17·5 years. A total of 637 participants with valid homeostasis model assessment (HOMA) index data and who completed at least a 2 d 24 h dietary recall were included in the study (60% of the total HELENA-CSS sample). There were two dietary indices calculated, with the only difference between them being the inclusion or not of physical activity (PA). Markers of IR such as HOMA and the quantitative insulin sensitivity check index (QUICKI) were calculated. Pubertal status, BMI and cardiorespiratory fitness (CRF) were measured as potential confounders. The dietary index including PA was inversely associated with HOMA and directly with the QUICKI in females, but not in males, after adjusting for pubertal status, centre, BMI and CRF. In conclusion, the present study indicates that considering PA as part of the dietary index is of relevance as the resulted index is inversely related to IR independently of potential confounders including CRF. Overall, these findings suggest that intervention studies aimed at preventing IR in young people should focus on increasing the quality of the diet and also on including an optimal PA level in healthy adolescents.

The development and evaluation of the Australian child and adolescent recommended food score: a cross-sectional study

Background

Diet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. This study describes the development and evaluation of a brief food-based diet quality index for use with children at the individual or population level. The Australian Child and Adolescent Recommended Food Score (ACARFS) was developed to reflect adherence to the Dietary Guidelines for Children and Adolescents in Australia and modelled on the approach of the US Recommended Food Score.

Methods

The ACARFS has eight sub-scales and is scored from zero to 73. The diet quality score was evaluated by assessing correlation (Spearman’s correlations) and agreement (weighted κ statistics) between ACARFS scores and nutrient intakes, derived from a food frequency questionnaire in 691 children (mean age 11.0, SD 1.1) in New South Wales, Australia. Nutrient intakes for ACARFS quartiles were compared with the relevant Australian nutrient reference values.

Results

ACARFS showed slight to substantial agreement (κ 0.13-0.64) with nutrient intakes, with statistically significant moderate to strong positive correlations with all vitamins, minerals and energy intake (r = 0.42-0.70). ACARFS was not related to BMI.Participants who scored less than the median ACARFS were more likely to have sub-optimal intakes of fibre, folic acid and calcium.

Conclusion

ACARFS demonstrated sufficient accuracy for use in future studies evaluating diet quality. Future research on its utility in targeting improvements in the nutritional quality of usual eating habits of children and adolescents is warranted.

Dietary diversity score is a useful indicator of vitamin A status of adult women in Northern Kenya

OBJECTIVES

Diets consisting of diverse food items provide a wide range of nutrients that can enhance nutritional quality of the diet. Few studies have, however, assessed dietary diversity and its effects on micronutrient health in rural populations in field settings. This study assesses how well Dietary Diversity Score (DDS), an indicator of dietary diversity based on a simple count of food groups consumed, predicts the micronutrient status, focusing on serum vitamin A concentration.

METHODS

We used cross-sectional data from women in food-insecure northern Kenya where dietary diversity is likely critical for micronutrient health yet under-studied. A linear regression model was applied to examine the relationships between DDS and serum retinol concentration. A logistic regression model was used to test DDS as a predictor of vitamin A insufficiency (serum retinol < 1.05 μmol/l).

RESULTS

DDS had a significant positive effect on serum retinol concentration (t = 2.01, P = 0.045) after adjusting for age, wealth, acute phase reaction, hemoglobin, vitamin A intake and vitamin A supplementation. A one unit increase in DDS by adding an extra food group in one's diet was significantly less likely to have vitamin A insufficiency (OR = 0.64, P = 0.026) after adjusting for the covariates.

CONCLUSIONS

Our results indicate that diversified diets enhance vitamin A status relative to narrower diets with equivalent vitamin A content. DDS shows a potential as a low-cost, field-friendly method for exploratory assessments of vitamin A status, and a potential as a research tool for human biologists and anthropologists interested in dietary quality and micronutrient health.

Use of dietary indexes among children in developed countries

In this article, we review studies that have used dietary indexes to assess different aspects of diet in relation to health outcomes and sociodemographic factors in childhood populations of developed countries. Eighty-four papers published from 1980 to mid-2010 including 90 unique dietary indexes were reviewed. Seventy-two indexes were developed (or have been adapted) specifically for childhood populations; 38 of these were used to assess diet-disease associations, mostly of diet and obesity. In the majority of these studies, small inverse associations between dietary indexes and obesity indexes were shown. Children who were younger, female, and from high-income families had better dietary quality scores. Forty-nine indexes (of 90) were compared with other aspects of dietary intakes or behaviors, with correlations ranging from very low to modest (∼r = 0.05-0.50). Only 2 validation studies compared an index with nutritional biomarkers, and correlations were quite weak for most plasma nutrients (P < 0.10). Overall, a large number of indexes have been created and used, but the majority of studies are descriptive. Fewer analytic studies on index-health associations have been performed, and most analyses insufficiently adjusted for confounders. Thus, prospective and intervention research in diverse populations is needed to further test these tools. In conclusion, indexes are potentially useful methods for dietary assessment, because they offer valuable information on overall dietary patterns in children. However, understanding the advantages and limitations when applying them in research and public health settings is important, and more research is needed to further develop their utility.

A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents

Studies assessing a relationship between consumption of 100% fruit juice by children and adolescents and weight are contradictory. The purpose of this review was to assess the 9 cross-sectional and 12 longitudinal studies that have looked at this association. Of the 9 cross-sectional studies reviewed, only 3 reported any association. Those studies used small, local convenience samples of preschool children; furthermore, selection criteria were not well defined. One found that preschool children consuming ≥ 12 fluid oz/day of 100% fruit juice had a higher prevalence of overweight than those who consumed less than 12 oz/day (32% vs 9%). Later, a separate study showed that this relationship held only for apple juice. Another study demonstrated an association of overweight and energy from juice. These 3 studies were not nationally representative. Only 3 of the longitudinal studies showed an association between 100% fruit juice consumption and weight; 1 found an association only in adolescent girls, and 2 reported an association in children who were already overweight. None of the longitudinal studies was nationally representative, but 5 had sample sizes of at least 1000, 2 were ethnically diverse, and 3 had geographically separate sites, suggesting that the findings could be applicable to wider populations. Based on the currently available evidence, it can be concluded that there is no systematic association between consumption of 100% fruit juice and overweight in children or adolescents. Data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of 100% fruit juice may be an important strategy to help children meet the current recommendations for fruit.