Abstract
BackgroundDiet 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.MethodsThe 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.ResultsACARFS 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.ConclusionACARFS 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.
Highlights
Diet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality
The Dietary Guideline Index for Children and Adolescents (DGI-CA) was found to be negatively associated with energy intake and positive associations were found with Body mass index (BMI) and waist-circumference z-scores in some age groups, they were considered weak with authors concluding that the DGI-CA was appropriate for use at the population level only [21]
Australian child and adolescent recommended food score The ACARFS was calculated for 691 children and was slightly skewed to the left
Summary
Diet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. The relationship between diet quality indices and nutritional adequacy and/or morbidity and mortality in adults has been reviewed [10] highlighting that across the 25 indices identified they are able to quantify risk for some health outcomes, including biomarkers of disease, incidence and risk of cardiovascular disease (CVD), some cancers and other chronic conditions and both cancer mortality and all-cause mortality [10]. These diet quality indices may be inappropriate for use in children due to age related differences in lifestyle, social influences, dietary intakes and dietary requirements [3]. The DGI-CA was found to be negatively associated with energy intake and positive associations were found with BMI and waist-circumference z-scores in some age groups, they were considered weak with authors concluding that the DGI-CA was appropriate for use at the population level only [21]
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