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

Sabri Bromage; Carolina Batis; Shilpa N Bhupathiraju; Wafaie W Fawzi; Teresa T Fung ORCID logo; Yanping Li ORCID logo; Megan Deitchler; Erick Angulo; Nick Birk ORCID logo; Analí Castellanos-Gutiérrez; +13 more... Yuna He; Yuehui Fang; Mika Matsuzaki ORCID logo; Yiwen Zhang; Mourad Moursi; Selma Gicevic; Michelle D Holmes; Sheila Isanaka ORCID logo; Sanjay Kinra ORCID logo; Sonia E Sachs; Meir J Stampfer; Dalia Stern; Walter C Willett; (2021) Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS). The Journal of nutrition, 151 (12 Sup). 75S-92S. ISSN 0022-3166 DOI: 10.1093/jn/nxab244
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BACKGROUND: Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. OBJECTIVES: We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. METHODS: Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. RESULTS: We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). CONCLUSIONS: The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.

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