Publications

Background

The Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related non-communicable disease risk in diverse populations. A software application (GDQS app) was developed for standardized collection of GDQS data. The app involves a simplified 24-hour 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.

Objective

To estimate associations between GDQS scores, collected using the GDQS app, and nutrient adequacy and metabolic risks.

Design

In this cross-sectional study of 600 Thai men and non-pregnant/non-lactating women (40-60 years) we collected 2 days of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between app scores and outcomes were estimated using multiple regression, and app performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity–Women, Alternative Healthy Eating Index–2010, Global Dietary Recommendations score.

Results

In covariate-adjusted models, app 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%). App scores were inversely associated with BMI (Q1-Q5: 26.3-24.9 kg/m²), body fat percentage (Q1-Q5: 31.7-29.1%), diastolic blood pressure (Q1-Q5: 84-81 mmHg), and a locally-developed sodium intake score (Q1-Q5: 27.5-24.0 points out of 100); positively associated with HDL-C (Q1-Q5: 49-53 mg/dL) and 24-hour urinary potassium (Q1-Q5: 1385-1646 mg); and inversely associated with high mid-upper arm circumference (Q5/Q1 OR: 0.52) and abdominal obesity (Q5/Q1 OR: 0.51). Significant associations for the app outnumbered those for metrics computed using 24HR or FFQ.

Conclusion

The GDQS app is effective for assessing nutrient adequacy and metabolic risk in population surveys.

Food industries are developing new processing technologies, resulting in the emergence of new product categories, including ready-to-eat meals, functional foods and beverages, and plant-based foods, etc. Rapid globalization, changes in lifestyle, consumer awareness, and perception toward food drive further technical advancements. However, consumer perception remains the prime factor for food marketing and technological development. Consumer perception is a trifecta of sensory properties, personal and environmental factors. Sensory and personal factors include consumer age, attitude, health condition, nutrition awareness, and religion which directly influence consumer choice. Whereas environmental factors consist of regional variation in the food process, national economic status, and consumer purchasing power. All these factors affect consumers’ decisions to accept or reject foods. Additionally, consumers are more willing to taste innovative food products that assure the safety and quality of the product.

Background

There remains a need to identify low-cost interventions to improve COVID-19 outcomes. Vitamin D and zinc play a role in respiratory infections, and could hold value as part of therapeutic regimens.

Objective

To determine the effect of vitamin D or zinc supplementation on recovery from COVID-19.

Methods

We conducted a double-blind randomized 2x2 factorial placebo-controlled trial with 1:1:1:1 allocation ratio, enrolling non-pregnant adults with COVID-19 from hospitals in Mumbai and Pune, India (NCT04641195). Participants (N=181) were randomized to vitamin D3 (180,000IU bolus, then 2000IU daily), zinc (40mg daily), vitamin D3 and zinc, or placebo, for 8 weeks. Participants were followed until 8 weeks. The primary outcome was time to resolution of fever, cough, and shortness of breath. Secondary outcomes were duration of individual symptoms; need for assisted ventilation; duration of hospital stay; all-cause mortality; and blood biomarkers including nutritional, inflammatory and immunological markers.

Results

We observed no effect of vitamin D or zinc supplementation on time to resolution of all three symptoms (vitamin D hazard ratio [HR]: 0.92, 95% confidence interval [95% CI]: 0.66-1.30, P=0.650; zinc HR: 0.94, 95% CI: 0.67-1.33, P=0.745). Neither vitamin D nor zinc supplementation was associated with secondary outcomes, except for increased endline serum vitamin D with vitamin D supplementation (median [interquartile range] difference between endline and baseline for vitamin D: 5.3ng/mL [-2.3-13.7]; for no vitamin D: -1.4ng/mL [-5.6-3.9]; P=0.003). We observed non-significant increases in serum zinc at endline following zinc supplementation. There was no evidence of interaction between vitamin D and zinc supplementation; no effect of either on hypercalcemia; and no adverse events.

Conclusions

Results suggest that neither vitamin D nor zinc supplementation improve COVID-19 treatment outcomes in this population. However, much larger-scale evidence, particularly from populations with vitamin D or zinc deficiency and severe infection, is required to corroborate our findings.

Mongolia is severely affected by adverse climate change impacts, including substantially higher temperatures that have contributed to increased evapotranspiration and the drying up of the country’s water resources. Moreover, the number and intensity of extreme events--especially droughts--is growing, with largest impacts on the poorer population employed in agriculture. At the same time, nutrition security remains out of reach with the co-existence of multiple forms of malnutrition, including obesity. The Mongolian pastoral culture is important to consider in balancing nutritional requirements, health risks, economics, sustainability of food production, including greenhouse gas emissions. While linkages between climate change and food security are increasingly understood, in particular the direct impacts of climate change on crop yields, associated higher food prices, and increased costs of healthy diets resulting in higher levels of malnutrition, other linkages between climate change and nutrition have been barely studied. Mongolia thus suffers from the syndemic of climate change, obesity and undernutrition, which are three co-occurring and interlinked epidemics.

A better and more comprehensive understanding of the linkages between climate change and nutrition is key to developing effective interventions to ensure that Mongolia’s population has access to sufficient, safe and nutritious food despite adverse climate outcomes. Importantly, climate change does not only affect food production but can exacerbate malnutrition by removing food and nutrients in all stages of the food value chain. Finally, given the important contribution of food systems to climate change, nutrition policy in Mongolia should more proactively consider environmental impacts.

Adolescents face the risk of the triple burden of malnutrition—the co-existence of micronutrient deficiencies, underweight and overweight and obesity and related noncommunicable diseases. Poor-quality diets are a modifiable risk factor for all forms of malnutrition in adolescents. However, there is limited knowledge about diet quality for African adolescents. We analyzed data from 4609 school-going adolescents aged 10–15 years in Burkina Faso, Ethiopia, Sudan and Tanzania. Dietary intake was assessed using food frequency questionnaires, and diet quality computed using the Global Diet Quality Score (GDQS). Generalized estimating equations linear regression models were used to evaluate factors associated with adolescent diet quality. Mean adolescent age was 12.4 (±1.4) years and 54% of adolescents were female. Adolescents reported physical activity on 1.5 (±1.7) days/week. The mean GDQS (±SD) was 20.6 (±4.0) (maximum 40). Adolescent consumption of vegetables, fruit, nuts and seeds, eggs, fish and poultry was low, and refined grain consumption was relatively high. Boys consumed unhealthy foods less frequently but consumed fewer cruciferous vegetables and deep orange tubers. Older adolescents had higher fish and lower red meat consumption. Having an unemployed mother versus farmer (estimate −2.60, 95% confidence interval [CI]: −4.81, −0.39), and having 3–4 days of physical activity per week versus none (estimate 0.64, 95% CI: 0.11, 1.17) were associated with GDQS. We found evidence of poor-quality adolescent diets and gender and age differences in the consumption of healthy diets. Programs to address poor-quality diets should consider tailoring interventions for adolescent girls and boys of different ages and also consider the role of physical activity in these contexts.

In the context of clinical and epidemiologic research, dietary intake is a particularly complex exposure to measure given the vast diversity of foods consumed globally, with variation in consumption patterns across eating occasions, days, seasons, and the life cycle. Assessing intake is challenged by measurement error arising from various sources, including imperfect recall of foods consumed in retrospective assessments, such as 24-hour diet recalls and food-frequency questionnaires, and reactivity associated with real-time recording in the case of food records. In analysis and interpretation, further complexity is introduced by the diversity of dietary components often of interest in a given study, related to the growing recognition of the need to account for the multidimensionality of intake to holistically characterize and translate the effects of dietary patterns on health and disease risk. These challenges, resulting gaps in the quantity and quality of dietary intake data available for populations globally, and resulting deficits in time-relevant and evidence-based strategies for improving dietary patterns continue to inspire innovative approaches that attempt to surmount challenges faced by conventional dietary assessment methods. As of October 2022, this methods collection includes seven video articles describing the development, evaluation, and/or application of innovative dietary assessment and analysis methods and tools that researchers may consider applying in their own work. Three of the articles describe the protocol for developing the method to assist interested researchers in creating similar methods tailored to specific settings or populations. The methods incorporate aspects of nutritional, behavioral, and computer science and mechanical, electrical, and software engineering, highlighting the importance of broad interdisciplinary and integrative perspectives to innovation in this field.

Importance  Vitamin D deficiency (defined as 25-hydroxyvitamin D [25(OH)D] <20 ng/mL) is prevalent among children living in temperate climates and has been reported to associate independently with stunting, obesity, and early activation of the hypothalamic-pituitary-gonadal axis. Phase 3 randomized clinical trials to investigate the influence of long-term vitamin D replacement on growth, body composition, and pubertal development of school-aged children with vitamin D deficiency are lacking.

Objective  To determine whether weekly oral vitamin D supplementation influences linear growth, body composition, or pubertal development in school-aged children living in a setting where vitamin D deficiency is highly prevalent.

Design, Setting, and Participants  This secondary analysis of a double-blind, placebo-controlled randomized clinical trial was conducted from June 2016 to June 2019 at 18 grade schools in Ulaanbaatar, Mongolia. School-aged children (6 to 13 years at baseline) attending participating schools were included. Exclusion criteria included a positive QuantiFERON-TB Gold in-tube assay result, conditions or medications associated with altered vitamin D metabolism, use of vitamin D supplements, signs of rickets, or intention to move from Ulaanbaatar within 4 years. Of 11 475 children invited to participate in the study, 9814 underwent QFT testing, and 8851 with negative results were included in the study. All but 1 participant in the placebo group completed follow-up and were included in the present analysis. Data were analyzed from November 2021 to February 2022.

Interventions  Weekly oral doses of vitamin D₃, 14 000 IU, (n = 4418), or placebo (n = 4433) for 3 years.

Main Outcomes and Measures  Mean z scores for height for age, body mass index for age, and waist-to-height ratio; mean percentage body fat, fat mass, and fat-free mass; and mean Tanner scores for pubertal development.

Results  Of 8851 participants, 4366 (49.3%) were female, and 8165 (92.2%) were of Khalkh ethnicity; the mean (SD) age was 9.4 (1.6) years. A total of 8453 participants (95.5%) were vitamin D deficient at baseline, and mean end-of-study 25(OH)D concentrations among participants randomized to vitamin D vs placebo were 31.0 vs 10.7 ng/mL (mean difference, 20.3; 95% CI; 19.9-20.6). However, vitamin D supplementation did not influence mean height for age, body mass index for age, waist-to-height ratio, percentage body fat, fat mass, fat-free mass, or Tanner scores, either overall or within subgroups defined by baseline 25(OH)D concentration less than 10 ng/mL vs 10 ng/mL or greater, estimated calcium intake less than 500 mg/d vs 500 mg/d or greater, or male vs female sex.

Conclusions and Relevance  In school-aged children in this study with low baseline vitamin D status, oral vitamin D₃ supplementation at a dose of 14 000 IU per week for 3 years was effective in elevating 25(OH)D concentrations but did not influence growth, body composition, or pubertal development.

Trial Registration  ClinicalTrials.gov Identifier: NCT02276755

It can be challenging to calculate nutrient intakes in population diet surveys because existing nutritional analysis software is generally oriented toward analyzing intakes of individuals and may not allow users to input or easily modify the food composition data used in the analysis. These are drawbacks that are more problematic in low- and middle-income country settings. While there are numerous software-assisted dietary assessment platforms that conduct onboard nutritional analysis and are appropriate for use in large surveys, they are often similarly limited, and further restrict users to specific assessment modalities. This paper presents a multifunctional system of integrated spreadsheets for nutritional analysis of population diet surveys (ISNAPDS) that provides a solution for situations in which data have been collected but cannot be adequately analyzed with existing software. The protocol involves supplying the system with fully customizable data on food composition, food group classifications, and food intake (food intake in g/day may be entered directly or calculated based on user-supplied intake frequencies and either standard or variable serving sizes). Following data entry, the user modifies a set of simple pre-populated formulas to match them to the structure of the input data and the system applies these formulas to calculate nutrient and food group intakes, and the contributions of food groups to nutrient intakes for all members of the survey population. The flexibility of the ISNAPDS system allows it to accommodate the global diversity of foods consumed and analyze quantitative, semiquantitative, and nonquantitative food consumption data collected using prospective and retrospective assessment methods employing different reference periods and portion size estimation methods. To date, the system has been applied in published and ongoing analyses of 24 h recall, diet record, food frequency, and disaggregated household consumption data from population surveys in China, Ethiopia, India, Mongolia, Thailand, and a multi-country analysis of 10 sub-Saharan African countries.

BACKGROUND: India has the highest prevalence of multidrug-resistant TB (MDR-TB) globally. Vitamin D deficiency is potentially an important risk factor for MDR-TB. METHODS: We conducted a case-control study of 90 newly diagnosed adult MDR-TB cases, 180 household controls and 82 non-household controls in Mumbai, India. Serum 25-hydroxyvitamin D (25(OH)D), anthropometry, clinical status and history, dietary data and sociodemographic data were collected from each participant. Interferon-gamma release assay (IGRA) was also performed in controls to assess latent TB. Multivariable regression was performed to estimate associations between 25(OH)D vs. case status and IGRA positivity. RESULTS: Mean participant age was 33.8 ± 12.0 years; 72.8% had 25(OH)D <20 ng/ml. Mean 25(OH)D was significantly (P < 0.05) lower in cases (12.5 ± 7.9) than both household (17.5 ± 11.2) and non-household controls (16.4 ± 9.1). In multivariable models, 25(OH)D concentration was inversely associated with MDR-TB case status among cases and household controls (OR 0.95 per 1 ng/ml, 95% CI 0.92-0.99; P = 0.015), and among cases and non-household controls (OR 0.94 per 1 ng/ml, 95% CI 0.89-1.00; P = 0.033); 53.6% of controls were IGRA-positive. 25(OH)D status was not associated with IGRA positivity. CONCLUSION: Vitamin D status was independently associated with MDR-TB case status. Research should evaluate the effectiveness of vitamin D supplementation in prevention and adjunctive treatment of MDR-TB.

Introduction: Presently, there are few population-level strategies to address SARS-CoV-2 infection except preventive measures such as vaccination. Micronutrient deficiency, particularly vitamin D and zinc deficiency, has been associated with dysregulated host responses, and may play an important role in COVID-19.

Methods and analysis: We have designed a 2×2 factorial, randomised, double-blind, multi-centre placebo-controlled trial to evaluate the effect of vitamin D and zinc on COVID-19 outcomes in Maharashtra, India. COVID-19 positive individuals are recruited from hospitals in Mumbai and Pune. Participants are provided (1) vitamin D3 bolus (180 000 IU) maintained by daily dose of 2000 IU and/or (2) zinc gluconate (40 mg daily), versus placebo for 8 weeks. Participants undergo a detailed assessment at baseline and at 8 weeks, and are monitored daily in hospital or every 3 days after leaving the hospital to assess symptoms and other clinical measures. A final follow-up telephone call occurs 12 weeks post-enrolment to assess long-term outcomes. The primary outcome of the study is to time to recovery, defined as time to resolution of all of fever, cough and shortness of breath. Secondary outcomes include: duration of hospital stay, all-cause mortality, necessity of assisted ventilation, change in blood biomarker levels and individual symptoms duration. Participant recruitment commenced on April 2021.

Ethics and dissemination: Ethical approval was obtained from institutional ethical committees of all participating institutions. The study findings will be presented in peer-reviewed medical journals.

Trial registration numbers: NCT04641195, CTRI/2021/04/032593, HMSC (GOI)-2021-0060.

Keywords: COVID-19; clinical trials; nutrition.

BACKGROUND: Access to high-quality dietary intake data is central to many nutrition, epidemiology, economic, environmental, and policy applications. When data on individual nutrient intakes are available, they have not been consistently disaggregated by sex and age groups, and their parameters and full distributions are often not publicly available. OBJECTIVES: We sought to derive usual intake distributions for as many nutrients and population subgroups as possible, use these distributions to estimate nutrient intake inadequacy, compare these distributions and evaluate the implications of their shapes on the estimation of inadequacy, and make these distributions publicly available. METHODS: We compiled dietary data sets from 31 geographically diverse countries, modeled usual intake distributions for 32 micronutrients and 21 macronutrients, and disaggregated these distributions by sex and age groups. We compared the variability and skewness of the distributions and evaluated their similarity across countries, sex, and age groups. We estimated intake inadequacy for 16 nutrients based on a harmonized set of nutrient requirements and bioavailability estimates. Last, we created an R package-nutriR-to make these distributions freely available for users to apply in their own analyses. RESULTS: Usual intake distributions were rarely symmetric and differed widely in variability and skewness across nutrients and countries. Vitamin intake distributions were more variable and skewed and exhibited less similarity among countries than other nutrients. Inadequate intakes were high and geographically concentrated, as well as generally higher for females than males. We found that the shape of usual intake distributions strongly affects estimates of the prevalence of inadequate intakes. CONCLUSIONS: The shape of nutrient intake distributions differs based on nutrient and subgroup and strongly influences estimates of nutrient intake inadequacy. This research represents an important contribution to the availability and application of dietary intake data for diverse subpopulations around the world.

In contrast to nutrient pro!ling models that evaluate the overall nutritional value of individual foods, food-based diet quality metrics attempt to characterize the collective contribution of foods to health. The two approaches are complementary means of providing a quantitative basis upon which to develop programmatic guidance for improving population diets. In this article, we describe a novel food-based metric of diet quality for global use, and key takeaways of our research to develop and evaluate this metric.

Despite contributing to healthy diets for billions of people, aquatic foods are often undervalued as a nutritional solution because their diversity is often reduced to the protein and energy value of a single food type (‘seafood’ or ‘fish’). Here we create a cohesive model that unites terrestrial foods with nearly 3,000 taxa of aquatic foods to understand the future impact of aquatic foods on human nutrition. We project two plausible futures to 2030: a baseline scenario with moderate growth in aquatic animal-source food (AASF) production, and a high-production scenario with a 15-million-tonne increased supply of AASFs over the business-as-usual scenario in 2030, driven largely by investment and innovation in aquaculture production. By comparing changes in AASF consumption between the scenarios, we elucidate geographic and demographic vulnerabilities and estimate health impacts from diet-related causes. Globally, we find that a high-production scenario will decrease AASF prices by 26% and increase their consumption, thereby reducing the consumption of red and processed meats that can lead to diet-related non-communicable diseases while also preventing approximately 166 million cases of inadequate micronutrient intake. This finding provides a broad evidentiary basis for policy makers and development stakeholders to capitalize on the potential of aquatic foods to reduce food and nutrition insecurity and tackle malnutrition in all its forms.

The Sustainable Development Goals (SDGs) are intricately linked to food systems. Addressing challenges in food systems is key to meeting the SDGs in Africa and South Asia, where undernutrition and micronutrient deficiencies persist, alongside increased nutrition transition, overweight and obesity, and related chronic diseases. Suboptimal diets are a key risk factor for mortality and 3 billion people cannot afford a healthy diet; in addition, food systems are not prioritizing environmental sustainability. Optimizing food systems and increasing agricultural productivity beyond calories, to nutrient-rich vegetables and fruits, legumes, and livestock, and sustainable fishing, are required. Strengthening of research around food systems—on pathways, value chains, and development and validation of metrics of diet quality—is required. The development of new technology in crop management and pest control and addressing natural resource degradation is key. Engaging with the public and private sectors, outreach to donors and policymakers, and strengthening cross-disciplinary collaborations are imperative to improving food systems.

Background: In response to India’s unacceptably high burden of anemia among children aged 6–59 mo, the central government introduced the National Iron Plus Initiative program which recommends an intervention of iron supplementation to mitigate anemia, especially iron deficiency anemia. Objective: The objective of this study was to examine the trend (between 2005–2006 and 2015–2016) in receiving weekly iron supplementation (WIS) among children aged 6–59 mo, and factors associated with receiving WIS during 2015–2016.

Methods: Two waves of the nationally representative cross-sectional National Family Health Survey (NFHS) data collected during 2005–2006 (NFHS-3) and 2015–2016 (NFHS-4) were used. The trend was measured using both rounds of datasets, whereas factors associated with WIS receipt were assessed from NFHS-4. The trend was assessed using a sample of 35,650 children from NFHS-3 and 202,227 children from NFHS-4. After exclusion of 8978 cases, a total of 199,110 children were included to analyze the factors associated with receiving WIS. Using appropriate sample weighting, unadjusted and adjusted (multivariate) logistic regression analyses were deployed. Application of the chi-squared test and checking for multicollinearity were also part of the analysis. The possibility of sample selection bias was tested.

Results: An increase of WIS receipt (from 4.6% in 2005–2006 to 26% in 2015–2016) was observed. Older children, children living in rural areas, children belonging to Scheduled Tribes, children of mothers with secondary education or higher, and children whose mothers had some mass media exposure had higher odds of receiving WIS. Children of fifth or higher birth order, children who were followers of Islam and Christianity, children from the richest economic group, noninstitutional birth of children, and children from high-focus group states were negatively associated with WIS receipt.

Conclusions: Despite improvement (between 2005–2006 and 2015–2016) in receiving WIS, coverage remains unacceptably low (in absolute terms). The suboptimum performance of WIS intervention demands further investigation.

 

Objective: We assessed the ability of the Prime Diet Quality Score (PDQS) to predict mortality in a United States (U.S.) population and compared its predictiveness with that of the Healthy Eating Index-2015 (HEI-2015).

Design: PDQS and HEI-2015 scores were derived using two 24-hour recalls and converted to quintiles. Mortality data were obtained from the 2015 Public-Use Linked Mortality File. Associations between diet quality and all-cause mortality were evaluated using multivariable Cox proportional hazards models, and predictive performance of the two metrics were compared using a Wald test of equality of coefficients with both scores in a single model. Finally, we evaluated associations between individual metric components and mortality.

Setting: A prospective analysis of the U.S. National Health and Nutrition Examination Survey (NHANES) data.

Participants: 5,525 participants from three survey cycles (2003-2008) in the NHANES aged 40 years and over.

Results: Over the 51,248 person-years of follow-up (mean: 9.2 years), 767 deaths were recorded. In multivariable models, hazard ratios between the highest and lowest quintiles of diet quality scores were 0.70 (95%CI: 0.51, 0.96, p-trend=0.03) for the PDQS, and 0.77 (95%CI: 0.57, 1.03, p-trend=0.20) for the HEI-2015. The PDQS and HEI-2015 were similarly good predictors of total mortality (p-difference=0.88).

Conclusion: Among U.S. adults, better diet quality measured by the PDQS was associated with reduced risk of all-cause mortality. Given that the PDQS is simpler to calculate than the HEI-2015, it should be evaluated further for use as a diet quality metric globally.

Keywords: Healthy Eating Index-2015; NHANES; Prime Diet Quality Score; all-cause mortality; diet quality metrics.

Background

Valid and efficient tools for measuring and tracking diet quality globally are lacking.

Objective

The objective of the study was to develop and evaluate a new tool for rapid and cost-efficient diet quality assessment.

Design

Two screener versions were designed using Prime Diet Quality Score (PDQS), one in a 24-hour recall (PDQS-24HR) and another in a 30-day (PDQS-30D) food frequency format. Participants completed two 24-hour diet recalls using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) and 2 web-based diet quality questionnaires 7 to 30 days apart in April and May 2019. Both dichotomous/trichotomous and granular scoring versions were tried for each screener.

Participants/setting

The study included 290 nonpregnant, nonlactating US women (mean age ± standard deviation 41 ± 11 years) recruited via Amazon Mechanical Turk.

Main outcome measures

The main outcome measures were Spearman rank correlation coefficients and linear regression beta-coefficients between ASA24 nutrient intakes from foods and beverages and PDQS values.

Statistical analyses performed

The Spearman rank correlation and linear regression were used to evaluate associations of the PDQS values with ASA24 nutrient intakes from food, both crude and energy-adjusted. Correlations were de-attenuated for within-person variation in 24-hour recalls. Wolfe’s test was used to compare correlations of the 2 screening instruments (PDQS-24HR and PDQS-30D) with the ASA24. Associations between the ASA24 Healthy Eating Index 2015 and the PDQS values were also evaluated.

Results

Positive, statistically significant rank correlations between the PDQS-24HR values and energy-adjusted nutrients from ASA24 for fiber (r = 0.53), magnesium (r = 0.51), potassium (r = 0.48), vitamin E (r = 0.40), folate (r = 0.37), vitamin C (r = 0.36), vitamin A (r = 0.33), vitamin B6 (r = 0.31), zinc (r = 0.25), and iron (r = 0.21); and inverse correlations for saturated fatty acids (r = –0.19), carbohydrates (r = –0.22), and added sugar (r = –0.34) were observed. Correlations of nutrient intakes assessed by ASA24 with the PDQS-30D were not significantly different from those with the PDQS-24HR. Positive, statistically significant correlations between the ASA24 Healthy Eating Index 2015 and the PDQS-24HR (r = 0.61) and the PDQS-30D (r = 0.60) were also found.

Conclusions

The results of an initial evaluation of the PDQS-based diet quality screeners are promising. Correlations and associations between the PDQS values and nutrient intakes were of acceptable strength and in the expected directions, and the PDQS values had moderately strong correlations with the total Healthy Eating Index 2015 score. Future work should include evaluating the screeners in other population groups, including men, and piloting it across low- and middle-income countries.