Changes in the Global Diet Quality Score, Weight, and Waist Circumference in Mexican Women

Associations between the Global Diet Quality Score and risk of type 2 diabetes: Tehran lipid and glucose study

BACKGROUND

Previous studies reported that focusing on healthy lifestyle, especially high diet quality is necessary for preventing type 2 diabetes (T2D). This study investigated the association between the innovative index, the Global Diet Quality Score (GDQS), and the risk of Type 2 Diabetes incidence.

METHODS

In this secondary analysis, we included elective adult participants (n = 5948) from the third and fourth survey of the Tehran Lipid and Glucose Study. Participants checked out until the sixth phase with an average follow-up of 6.65 years. Expert nutritionists collected dietary data using a valid and reliable semi-quantitative food frequency questionnaire. The GDQS were calculated, including healthy and unhealthy food group scores. Biochemical and anthropometric characteristics were assessed during the first and follow-up surveys. Multivariable Cox proportional hazards regression models were used to estimate the progression of T2D in association with the GDQS.

RESULTS

This study was implemented on 2,688 men and 3,260 women, respectively with the mean (SD) age of 41.5(14.1) and 39.3(13.02) years. A total of 524 subjects were found to have had T2D incidence. The healthy component of GDQS was conversely associated with T2D incidence [HR: 1, 0.91 (0.84-0.98), 0.91 (0.84-0.98), 0.84 (0.77-0.92) P trend = <0.001] in an adjusted model. The unhealthy component of GDQS was conversely associated with T2D incidence in an adjusted model [HR: 1, 0.86 (0.80-0.92), 0.93 (0.86-1.01), 0.89 (0.81-0.98) P trend = 0.009].

CONCLUSION

The results of this study suggested that higher adherence to the healthy component of GDQS and lower intake of the unhealthy component decreased the risk of T2D incidence.

The feasibility of using the application developed to operationalize the Global Diet Quality Score in Ethiopia

BACKGROUND

The Global Diet Quality Score (GDQS) application is an electronic data collection tool developed to provide a standard, easy-to-use method for collecting low-cost, time-relevant data on diet quality.

OBJECTIVE

To assess the feasibility and ease-of-use of the GDQS application and associated set of 3D cubes used as visual aids to assist the respondent with estimating amounts consumed at the food group level.

METHODS

The study was conducted in August 2021 in two regions of Ethiopia with varied dietary practices. Face-to-face interviews were conducted in Amharic and Somali by 10 enumerators among 120 women to collect dietary data using the GDQS application. Feedback on each completed interview was collected from both the respondent and enumerator. Enumerators also participated in focus group discussions.

RESULTS

Enumerators rated the GDQS application as easy to use after 85.8% of the interviews completed. They identified the automatic provision of food-specific probes to guide the interview, the automatic classification of reported foods, beverages, and ingredients into the corresponding GDQS food groups, and the ability to work offline as the main advantages of the application. Most respondents (78.3%) did not find it difficult to choose the cube that corresponded to the amount of each food group they reported consuming. Respondents' feedback on the open recall of all foods, beverages and mixed dishes consumed the previous day and the use of 3D cubes was mostly positive.

CONCLUSION

The results suggest that the GDQS application and cubes were easy to use and feasible for collecting data on diet quality in a low-income country setting.

Cross-context equivalence and agreement of healthy diet metrics for national and global monitoring: a multicountry analysis of cross-sectional quantitative 24-hour dietary intake studies

BACKGROUND

Despite national and global commitments to improve nutrition, there are no universally accepted indicators for at-scale monitoring of diets. Several metrics have been proposed and used, but they vary in their comprehensiveness and validity in capturing the properties of healthy diets and, potentially, their interpretability across contexts.

OBJECTIVE

The objective of this study was to assess the cross-context equivalence and agreement of healthy diet metrics.

DESIGN

Quantitative 24-h dietary intake data from 57,456 nonpregnant females (15-49 y) in 21 countries were used to construct the food group diversity score (FGDS) and Minimum Dietary Diversity for Women indicator; the Global Diet Quality Score (GDQS) and its submetrics: GDQS+ and GDQS-; the Global Dietary Recommendations (GDR) score and its submetrics: noncommunicable disease (NCD)-Protect and NCD-Risk scores; and the All-5 indicator. Associations between (standardized) measures and indicators were quantified by fitting linear and logistic mixed-effect models across World Bank country income classifications, respectively. The levels of agreement between measures were assessed using Bland-Altman plots of z-scores, whereas rank correlations were assessed using Spearman's ρ.

RESULTS

The consumption of healthy food groups was positively associated with concurrent intakes of unhealthy food groups, in particular in high-income countries. Hence, metrics constructed using both healthy and unhealthy food groups (i.e., GDR score and GDQS) showed relatively less discriminatory capacity across country income classifications than their respective submetrics or FGDS. Standardized metrics of healthy (e.g., FGDS and GDQS+) and unhealthy food group consumption (i.e., NCD-Risk and GDQS-) exhibited strong agreement and correlations.

CONCLUSION

Composite metrics weighting both healthy and unhealthy food groups have limited cross-context equivalence, because a wide range of diets can theoretically return similar scores. Healthy food group (sub)metrics performed comparably, likely indicating strong underlying construct validity (i.e., dietary diversity and nutrient adequacy). For national and global monitoring, refinement and validation of unhealthy food group metrics (i.e., moderation) is recommended to complement healthy food group metrics.

Associations between Global Diet Quality Score and Risk of Metabolic Syndrome and Its Components: Tehran Lipid and Glucose Study

Background

Various food quality indicators have been proposed as tools for predicting metabolic syndrome (MetS). This study investigated the association between global diet quality score (GDQS) and the risks of developing MetS and its components.

Methods

In this secondary analysis, we included elective adult participants (n=4,548) from the Tehran Lipid and Glucose Study. Dietary data were collected by a valid and reliable semi-quantitative food frequency questionnaire. MetS was defined according to the Iranian modified National Cholesterol Education Program. Multivariable Cox proportional hazard regression models were used to estimate the incidence of MetS in association with GDQS.

Results

This study involved 1,762 men and 2,786 women with a mean±standard deviation age of 38.6±14.3 and 35.9±11.8 years, respectively. A total of 1,279 subjects developed MetS during the mean follow-up of 6.23 years. Incidence of MetS was associated with GDQS (hazard ratio [HR], 1.00; 0.90 [95% confidence interval, CI, 0.82 to 0.98]; 0.84 [95% CI, 0.76 to 0.91]; 0.80 [95% CI, 0.73 to 0.89]; P for trend <0.001) after adjusting for confounding variables. The healthy food group component of GDQS was related to MetS incidence. GDQS in the range of 12%-17% in the fourth quartile was associated with a decrease in incidence of MetS components. Both healthy and unhealthy food group components of the GDQS decreased the incidence of high triglycerides, high blood pressure, and high fasting blood glucose.

Conclusion

Higher GDQS was associated with a lower risk of the incidence of MetS or its components among Tehranian adults. Higher intake of healthy food group components and lower consumption of unhealthy food group components of the GDQS predicted lower MetS incidence and risk factors.

The global diet quality score as an indicator of adequate nutrient intake and dietary quality - a nation-wide representative study

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.

Mediterranean-Type Diet Adherence and Body Mass Index through 20 Years of Follow-Up: Results from the ATTICA Cohort Study (2002-2022)

Evidence of the association between dietary habits and long-term body weight status is scarce. This study aimed to evaluate changes in Mediterranean-type diet (MTD) adherence in relation to body weight during 20 years of follow-up. Data from n = 1582 participants from the ATTICA cohort study (2002-2022) were used. MTD adherence was assessed via MedDietScore, and body weight status via body mass index (BMI) by 3 different measurements. We found that MTD adherence and changes in this adherence were inversely related to BMI at 20 years and the mean BMI during the 20-year follow-up. In multi-adjusted linear regression models, a 1/55 increase in baseline, 10-year, and 20-year MedDietScore was associated with a decrease of 0.05-0.13 kg/m2 in BMI at 20 years and of 0.08-0.09 kg/m2 in the mean BMI. Being consistently close to the MTD for 20 years was associated with a >90% decreased risk of maintaining overweight/obesity during the 20-year period. Strong, protective, long-lasting effects of the MTD were observed, even in those who deviated from the MTD in the follow-up (41% of the sample). Our results highlight the need to focus on the overall diet quality to minimize the risk of maintaining an excessive body weight during the life-course.

Inverse Association between the Global Diet Quality Score and New-Onset Hypertension in Adults: A Nationwide Cohort Study

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.

Unhealthy diets increase the likelihood of being overweight or obese among African migrant students in China, but not among African non-migrant students: a cross-sectional study

Background

The impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data.

Methods

The researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries.

Results

Approximately 678 responses were received, mainly between 18-25 years (46.7%) and 26-36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students.

Conclusion

Controlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.

Consumption of 100% Fruit Juice and Body Weight in Children and Adults: A Systematic Review and Meta-Analysis

Importance

Concerns have been raised that frequent consumption of 100% fruit juice may promote weight gain. Current evidence on fruit juice and weight gain has yielded mixed findings from both observational studies and clinical trials.

Objective

To synthesize the available evidence on 100% fruit juice consumption and body weight in children and adults.

Data Sources

MEDLINE, Embase, and Cochrane databases were searched through May 18, 2023.

Study Selection

Prospective cohort studies of at least 6 months and randomized clinical trials (RCTs) of at least 2 weeks assessing the association of 100% fruit juice with body weight change in children and adults were included. In the trials, fruit juices were compared with noncaloric controls.

Data Extraction and Synthesis

Data were pooled using random-effects models and presented as β coefficients with 95% CIs for cohort studies and mean differences (MDs) with 95% CIs for RCTs.

Main Outcomes and Measures

Change in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was assessed in children and change in body weight in adults.

Results

A total of 42 eligible studies were included in this analysis, including 17 among children (17 cohorts; 0 RCTs; 45 851 children; median [IQR] age, 8 [1-15] years) and 25 among adults (6 cohorts; 19 RCTs; 268 095 adults; median [IQR] age among cohort studies, 48 [41-61] years; median [IQR] age among RCTs, 42 [25-59]). Among cohort studies in children, each additional serving per day of 100% fruit juice was associated with a 0.03 (95% CI, 0.01-0.05) higher BMI change. Among cohort studies in adults, studies that did not adjust for energy showed greater body weight gain (0.21 kg; 95% CI, 0.15-0.27 kg) than studies that did adjust for energy intake (-0.08 kg; 95% CI, -0.11 to -0.05 kg; P for meta-regression <.001). RCTs in adults found no significant association of assignment to 100% fruit juice with body weight but the CI was wide (MD, -0.53 kg; 95% CI, -1.55 to 0.48 kg).

Conclusion and Relevance

Based on the available evidence from prospective cohort studies, in this systematic review and meta-analysis, 1 serving per day of 100% fruit juice was associated with BMI gain among children. Findings in adults found a significant association among studies unadjusted for total energy, suggesting potential mediation by calories. Further trials of 100% fruit juice and body weight are desirable. Our findings support guidance to limit consumption of fruit juice to prevent intake of excess calories and weight gain.

Performance of the Global Diet Quality Score (GDQS) App in Predicting Nutrient Adequacy and Metabolic Risk Factors among Thai Adults

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.

Diet Quality and Consumption of Healthy and Unhealthy Foods Measured via the Global Diet Quality Score in Relation to Cardiometabolic Outcomes in Apparently Healthy Adults from the Mediterranean Region: The ATTICA Epidemiological Cohort Study (2002-2022)

The Global Diet Quality Score (GDQS) is a novel food-based score that assesses both nutrient adequacy and chronic disease risk, by evaluating healthy (GDQS+) and unhealthy foods (GDQS-). The aim of this study was to evaluate the association among GDQS, GDQS+, and GDQS- against the 20-year risk of cardiometabolic outcomes in a Mediterranean population. The sample was n = 2169 initially free of cardiovascular disease (CVD) participants of the ATTICA study (2002-2022) that participated in the 20-year follow-up. The incidence of CVD, hypertension, hypercholesterolemia, and type 2 diabetes mellitus (T2DM) was defined according to WHO-ICD-10 criteria. The GDQS was computed based on previously published instructions. In multivariate analyses, a higher diet quality, per 1/49 of the GDQS, was associated with an 8% [95% Confidence Interval-CI: 6-9%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. A higher consumption of healthy foods, per 1/32 of GDQS+, was associated with a 9% [95% CI: 7-11%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. Contrarily, a lower consumption of unhealthy foods (GDQS-) was not associated with cardiometabolic events in the adjusted models (all p value< 0.05). In clinical practice or future public health actions to ameliorate dietary habits and prevent CVD and T2DM, more attention should be focused on healthy foods that should be included in our diets.

Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS)

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.

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

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.

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

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.