Prime Diet Quality Score Research Articles

Impact of COVID-19 on Nutrition, Food Security and Dietary Diversity and Quality in Burkina Faso, Ethiopia and Nigeria

ObjectivesCOVID-19 has far-reaching consequences for developing countries through the combined effects of infection and mortality and unintended consequences from mitigation measures. COVID-19 can adversely impact food systems and dietary diversity for populations. This cross-sectional study evaluated, using a mobile platform, the effect of COVID-19 on food prices and dietary diversity and quality, among 1797 households in Nouna and Ouagadougou (Burkina Faso), Addis Ababa and Kersa (Ethiopia), and Lagos and Ibadan (Nigeria).MethodsDietary intake was assessed as the frequency of consumption of 20 food groups over the previous 7 days. Dietary diversity scores (DDS; range: 0–10) and Prime Diet Quality Score (PDQS; range: 0–40) assessed dietary diversity and quality. Linear regression models were used to evaluate associations between changes in the prices of staples, pulses, vegetables, fruits, and animal source foods (ASF) with DDS and PDQS during COVID-19.ResultsMost households reported increases in prices of staples, pulses, fruits, vegetables and ASF, and ≥40% reported decreased consumption of staples, legumes, ASF, other vitamin A rich vegetables, other vegetables and other fruits, and lower DDS and PDQS compared to the period before the COVID-19 emergency. Increases in pulse prices were associated with lower DDS (estimate − 0.35, 95% CI: −0.61, −0.09). Lower crop production (estimate − 0.70, 95% CI: −1.02, −0.37), and skipping meals (estimate − 0.39, 95% CI: −0.56, −0.21) or not eating for a whole day (estimate − 0.23, 95% CI: −0.43, −0.03) were also associated with lower DDS.ConclusionsThe price increases and worsening dietary diversity and quality call for social protection and other strategies to increase the availability and affordability of nutrient-rich foods during the COVID-19 pandemic and other public health emergencies.Funding SourcesThe Bill and Melinda Gates Foundation Grant as well as institutional support from the Heidelberg Institute of Global Health, Germany and the Harvard T.H. Chan School of Public Health, USA, supported this work.

Association Between Diet Quality and Infant Birthweight Among Pregnant Women in a Peri-Urban Hospital Setting in Nepal

ObjectivesMaternal dietary quality has been related to fetal growth and infant birthweight but evidence is inconclusive and only a few studies have been conducted in low-income countries including Nepal. The aim of this study was to prospectively examine the association between diet quality in the 3rd trimester of pregnancy and infant birthweight in a pregnancy cohort in Nepal. MethodsIn total, 101 singleton pregnant women (age 25.9 ± 4.1 years) were recruited from a tertiary, peri-urban hospital in Dhulikhel, Nepal. In the 3rd trimester, an adapted Nepali version of the PrimeScreen questionnaire was administered, which assessed diet quality [Prime Diet Quality Score (PDQS) range: 0–42; higher score means better diet quality] based on consumption frequency of 12 healthy and 9 unhealthy food groups. Infant birthweight data was extracted from medical records. Linear regression estimated the association between diet quality and infant birthweight, adjusting for age, education, ethnicity, and pre-pregnancy BMI. Adjusting for the same covariates, a logistic regression model was used to estimate the odds ratio (OR) and 95% CI for the association between diet quality and low birthweight (LBW; birthweight < 2500 grams). ResultsThe mean PDQS at the 3rd trimester was 22.6 ± 1.3 (range: 20–25) out of 42. Mean infant birthweight was 2979.0 ± 423.2 (range: 2245–4705) grams. Overall, 12.9% were small for gestational age and 4% were large for gestational age. There was no significant linear association between diet quality and infant birthweight [adjusted β (95% CI) = –10.3 (–66.4, 86.9); p = 0.79]. However, higher maternal diet quality was significantly associated with 48% reduced odds of LBW infant [adjusted OR (95% CI) = 0.52 (0.31, 0.87); p = 0.013]. ConclusionsHigher diet quality in the 3rd trimester of pregnancy was associated with lower risk of giving birth to a LBW infant among pregnant women from a peri-urban setting in Nepal. Larger population-based studies using comprehensive diet assessment tools are needed to confirm and expand these findings. Funding SourcesRutgers Global Health Institute.

Diet Quality Indices in the SUN Cohort: Observed Changes and Predictors of Changes in Scores Over a 10-Year Period

BackgroundDietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood. ObjectiveTo evaluate within-participant longitudinal changes in scores for nine a priori–defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the “Seguimiento Universidad de Navarra” (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up. DesignIn this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ). Participants/settingSpanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7). Main outcome measuresMain outcome measures were within-participant longitudinal changes for FQI, CQI, PVG, MEDAS, MDS, DASH, MIND, PDQS, and AHEI-2010. Statistical analyses performedAdjusted logistic regression models were used to evaluate within-participant longitudinal changes and to identify baseline predictors of improvements ≥10% in MEDAS and AHEI-2010 scores after 10 years of follow-up. ResultsThe comparison of the nine scores of DQI calculated at baseline and after 10 years of follow-up showed an improvement in all DQI scores except for PDQS. The greatest changes in DQIs were found for MEDAS (from 6.2 to 7.2, +22.9%) and MDS (from 4.3 to 4.4, +15.4%). The strongest predictors at baseline for ≥10% improvements in MEDAS or AHEI-2010 scores varied across indices. Being female, ≥35 years old, and more physically active at baseline were associated with improvement, whereas snacking between meals was associated with <10% improvements in both indices. ConclusionsIn this cohort, the changes in nine a priori-defined DQI scores suggested modest improvements in diet quality, in which MEDAS and MDS scores showed the largest improvements. Additional longitudinal studies, especially intervention trials with long follow-up, are warranted to establish the most appropriate DQIs to assess long-term changes in diet quality in adult populations.

Prospective evaluation of dietary and lifestyle pattern indices with risk of colorectal cancer in a cohort of younger women

Although colorectal cancer (CRC) incidence in the USA is declining overall, its incidence is increasing among those younger than 50 years of age. The reasons underlying the increasing trend are largely unknown, although behavioral changes, such as unhealthy diet and lifestyle factors, may be partially responsible. A prospective cohort study included 94217 women aged 26-45 years at baseline. Validated anthropometric measures and lifestyle information were self-reported biennially. Exposures were four recommendation-based dietary indices-the prime diet quality score and three plant-based dietary indices; and two mechanism-based indices-the empirical dietary and lifestyle index for hyperinsulinemia (EDIH and ELIH). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall CRC and for early-onset (before age 50) and after age 50 CRC separately. We documented 332 cases of CRC during 24 years of follow-up (2113655 person-years), with an average age of 52 ± 7 years at diagnosis. Hyperinsulinemic dietary and lifestyle patterns were associated with a higher risk of CRC. Multivariable-adjusted HRs (95% CIs) comparing participants in the highest versus lowest quartile were: 1.67 for EDIH (95% CI: 1.15-2.44, P-trend= 0.01) and 1.51 for ELIH (95% CI: 1.10-2.08, P-trend= 0.01). Moreover, per 75% increment in rank, ELIH appeared to be a stronger risk factor for early-onset CRC (HR= 1.86, 95% CI: 1.12-3.07) than after age 50 CRC (HR= 1.20, 95% CI: 0.83-1.73, P-heterogeneity= 0.16). The four recommendation-based indices were not significantly associated with overall, early-onset, or after age 50 CRC risk (per 75% increment in rank, HRs ranged from 0.75 to 1.28). Dietary and lifestyle patterns contributing to hyperinsulinemia were associated with greater CRC risk in younger women. Moreover, the hyperinsulinemic lifestyle showed a suggestively stronger positive association with early-onset CRC risk, compared with after age 50 CRC. Our findings suggest that dietary and lifestyle interventions to reduce insulinemic potential may be effective for CRC prevention among younger women.

China prime diet quality score

To Develop the China Prime Diet Quality Score(CPDQS) and evaluate the relationship between dietary quality and health-related outcomes in Chinese adults. CPDQS was conducted by 22 components, including dark green vegetables, dark red/orange vegetables, other vegetables, dark yellow fruits, citrus fruits, other fruits, whole grains/legumes, sweet potato, other potatoes, soybean, nuts, poultry, fish and shrimp, milk, eggs, red meat, fried food, refined grains, sugar sweetered beverages, salt, cooking oil, and alcohol. CPDQS components were selected based on Chinese Dietary Guidelines, and the values of each CPDQS components were set according to the dietary recommendations of foods and nutrients. According to the recommended amount of all kinds of foods under energy requirements of 2000 kcal in the Balanced Diet Pagoda, the basic score for each kind of food was 0-4, and the total score of the 22 components ranges from 0 to 100. Dietary quality of Chinese residents was evaluated according to CPDQS by analyzing data of adults aged 20-80 from Chinese Nutrition and Health Surveillance in 2010-2012. Mean of CPDQS for Chinese residents aged 20 and above was 40. 28±0. 08. CPDQS was higher in urban areas than in rural areas with median 48 and 39 respectively. CPDQS of female was slightly higher than that of male with median 44 and 43 respectively. CPDQS showed significantly correlation with all kinds of nutrients, in which correlation coefficient with carbohydrate and MPA was-0. 18 and 0. 35. With the increase of CPDQS score, the risk of overweight and obesity, abdominal obesity, hypertension, low high-density lipoprotein cholesterol-emia and metabolic syndrome decreased. After multi-factor adjustment, ORs of the highest quantile-group were 0. 73(95%CI 0. 63-0. 84), 0. 72(95%CI 0. 63-0. 83), 0. 67(95%CI 0. 57-0. 78), 0. 85(95%CI 0. 73-0. 99) and 0. 72(95%CI 0. 61-0. 85), respectively compared with the lowest quantile-group. CPDQS is a simplified index for comprehensive evaluation of dietary quality and it can reflect differences in diet quality among people in different regions and different health conditions. CPDQS could be used as an effective tool for evaluation of dietary quality.

Diet quality and all-cause mortality among US adults, estimated from National Health and Nutrition Examination Survey (NHANES), 2003-2008.

We assessed the ability of the Prime Diet Quality Score (PDQS) to predict mortality in the US population and compared its predictiveness with that of the Healthy Eating Index-2015 (HEI-2015). PDQS and HEI-2015 scores were derived using two 24-h 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 was 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. A prospective analysis of the US National Health and Nutrition Examination Survey (NHANES) data. Five-thousand five hundred and twenty-five participants from three survey cycles (2003-2008) in the NHANES aged 40 years and over. 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, Ptrend = 0·03) for the PDQS and 0·77 (95 % CI 0·57, 1·03, Ptrend = 0·20) for the HEI-2015. The PDQS and HEI-2015 were similarly good predictors of total mortality (Pdifference = 0·88). Among US 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.

Development of a Diet Quality Screener for Global Use: Evaluation in a Sample of US Women

BackgroundValid and efficient tools for measuring and tracking diet quality globally are lacking. ObjectiveThe objective of the study was to develop and evaluate a new tool for rapid and cost-efficient diet quality assessment. DesignTwo 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/settingThe study included 290 nonpregnant, nonlactating US women (mean age ± standard deviation 41 ± 11 years) recruited via Amazon Mechanical Turk. Main outcome measuresThe 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 performedThe 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. ResultsPositive, 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. ConclusionsThe 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.

Food Crop Diversity, Women's Income-Earning Activities, and Distance to Markets in Relation to Maternal Dietary Quality in Tanzania

BackgroundWomen's dietary diversity and quality are limited in low- and middle-income countries (LMICs). Nutrition-sensitive interventions that promote food crop diversity and women's access to income could improve diets and address the double burden of malnutrition in LMICs. ObjectivesWe examined the associations among food crop diversity and women's income-earning activities with women's diet quality, as well as effect modification by access to markets, in the context of small-holder food production in rural Tanzania. MethodsData from a cross-sectional study of 880 women from Rufiji, Tanzania, were analyzed. Women's dietary intake was assessed using a food frequency questionnaire. The prime diet quality score (PDQS; 21 food groups; range, 0–42), a unique diet-quality metric for women that captures the healthy and unhealthy aspects of diet, was computed. Generalized estimating equation linear models were used to evaluate the associations of food crop diversity and women's income-earning activities with PDQS, while controlling for socio-economic factors. ResultsMaternal overweight (24.3%) and obesity (13.1%) were high. The median PDQS was 19 (IQR, 17–21). Households produced 2.0 food crops (SD ± 1.0) yearly. Food crop diversity was positively associated with PDQS (P < 0.001), but the association was strengthened by proximity to markets (P for interaction = 0.02). For women living close (<1.1 km) to markets, producing 1 additional food crop was associated with a 0.67 (95% CI, 0.22–1.12) increase in PDQS, versus a 0.40 (95% CI, 0.24–0.57) increase for women living farther away. The PDQS increased with women's salaried employment (estimate, 0.96; 95% CI, 0.26–1.67). ConclusionsHousehold food production may interact with access to markets for sales and purchases, while nonfarm income also improves women's diet quality in rural Tanzania. Programs to improve women's diet quality should consider improving market access and women's access to income (source of empowerment), in addition to diversifying production.

Maternal dietary diversity and dietary quality scores in relation to adverse birth outcomes in Tanzanian women

Preterm birth (PTB), small for gestational age (SGA), and low birth weight (LBW) are risk factors for morbidity and mortality among infants. High-quality maternal diets during pregnancy may protect against these adverse birth outcomes. The aim of this study was to prospectively examine the association of maternal dietary diversity and quality during pregnancy with birth outcomes among women in Dar es Salaam, Tanzania. We analyzed data from 7553 HIV-negative pregnant women enrolled in a multivitamin trial at 12-27 weeks of gestation. Dietary intake was assessed using 24-h dietary recalls. Dietary diversity scores (DDS; range: 0-10) were computed as the number of food groups consumed by women, using FAO's Minimum Dietary Diversity for Women index. The Prime Diet Quality Score (PDQS; range: 0-42) assessed maternal diet quality based on consumption of 21 healthy and unhealthy food groups. Log binomial regression methods were used to assess associations of DDS and PDQS with PTB, SGA, LBW, and fetal loss. In the previous 24 h, 99.9% of all women had consumed cereal and staples, 57.9% meats, 4.7% eggs, and 0.5% nuts and seeds. Median DDS was 3.0 (IQR: 2.5-3.5). For the PDQS, all women consumed ≥4 servings/wk of green leafy vegetables and refined grains. Higher DDS was associated with lower risk of SGA (RR highest compared with lowest quintile: 0.74; 95% CI: 0.62, 0.89). Higher PDQS was associated with lower risk of PTB (RR highest compared with lowest quintile: 0.55; 95% CI: 0.46, 0.66), LBW (RR: 0.53; 95% CI: 0.40, 0.70), and fetal loss (RR: 0.53; 95% CI, 0.34, 0.82). PDQS was inversely associated with PTB, LBW, and fetal loss, and DDS was inversely associated with SGA. These findings suggest that in addition to dietary diversity, diet quality should be considered as important in understanding dietary risk factors for poor birth outcomes.This trial was registered at clinicaltrials.gov as NCT00197548.

Development and Evaluation of a Novel Diet Quality Screener for Global Use

Abstract Objectives Appropriate tools for measuring and tracking diet quality on a global scale are lacking. Such instruments need to be easy-to-use across various settings, and based on a metric associated with non-communicable diseases (NCDs) and key nutrient intakes. We developed and evaluated a diet quality screener among women in a high-income country setting. Methods The Prime Diet Quality Score (PDQS), a new food-based global diet quality index, shown to predict multiple NCDs among large U.S. cohorts, and associated with nutrient intake adequacy in low and middle-income countries (LMICs), was used to develop a short-form diet screener. Participants were recruited via Amazon MTurk to complete two 24-hour diet recalls (ASA24) and two screeners (PDQS-24HR and PDQS-30D) 7–30 days apart. Spearman rank correlation and linear regression were used to evaluate correlations and associations between usual nutrient intakes assessed by ASA24 and the PDQS values. We also compared the associations of the two score values with nutrient intakes by including them simultaneously in a regression model, and using a Wald test. Results The final sample included 290 U.S. women of reproductive age (41 ± 11). The median time required for completing the PDQS-24HR was 4.9 minutes, compared to 21 minutes for the ASA24. The rank correlations of the PDQS-24HR with energy-adjusted intakes of some key nutrients were 0.53 (fiber), 0.50 (β-carotene), 0.37 (folate), 0.31 (vitamin B6), 0.36 (vitamin C), 0.40 (vitamin E), 0.48 (potassium), 0.51 (magnesium), 0.25 (zinc), 0.21 (iron), 0.17 (PUFAs), −0.34 (added sugar), and −0.19 (SFA) (all P &amp;lt; 0.05). Correlations of the PDQS for vitamin B1 and calcium were null. Associations of nutrient intakes with the PDQS-30D were not significantly different from those with the PDQS-24HR. Conclusions The results of an initial evaluation of a stand-alone, PDQS-based diet quality screener among U.S. women are promising. Associations between the PDQS and nutrient intakes were of variable strength but in the expected directions. The lack of correlation for calcium intake warrants further examination: it may be partially attributed to the neutral scoring of key sources of this nutrient in U.S. diet. Future work should include piloting the screener across LMICs, and among children and adolescents. Funding Sources IMMANA Postdoctoral Fellowship(SG).

Maternal Dietary Diversity and Dietary Quality Scores in Relation to Adverse Birth Outcomes in Tanzanian Women

Abstract Objectives Preterm birth, small for gestational age (SGA) and low birth weight (LBW) are risk factors for morbidity and mortality among infants. High-quality maternal diets during pregnancy may protect against these adverse birth outcomes. The objective of this research is to prospectively examine the association of maternal dietary diversity and quality during pregnancy with birth outcomes among women in Dar es Salaam, Tanzania. Methods We analyzed data from 7553 HIV-negative pregnant women enrolled in a multivitamin trial at 12–27 weeks gestation. Dietary intake was assessed using 24-hour dietary recalls. Log binomial regression methods were used to assess associations of Minimum Dietary Diversity for Women (MDD-W) and Prime Diet Quality Score (PDQS) with preterm, SGA, LBW, fetal loss, very preterm, severe SGA and very low birth weight (VLBW). Results In the previous 24 hours, 99.9% of women reported consuming grains, roots and tubers, 57.9% meats, 4.7% eggs and 0.5% nuts and seeds. Median MDD-W score was 3.0 ± 1.0. For the PDQS, women consumed at least 4 servings/week of green leafy vegetables (100%) and other vegetables (64.7%) and consumption of refined grains was high (99.6%). Higher MDD-W scores were associated with lower risk of SGA (RR highest vs. lowest quintile 0.74, 95% CI: 0.62, 0.89). Higher PDQS scores were associated with lower risk of preterm birth (RR: 0.55, 95% CI: 0.46, 0.67); LBW (RR: 0.53, 95% CI: 0.40, 0.71); fetal loss (RR: 0.53, 95% CI: 0.34,0.82), very preterm (RR: 0.33, 95% CI: 0.17, 0.64) and VLBW (RR: 0.49, 95% CI: 0.26, 0.92) comparing women in highest vs. lowest quintiles. Conclusions PDQS was inversely associated with preterm, very preterm, LBW, VLBW and fetal loss, and MDD-W was inversely associated with SGA. These findings suggest that in addition to diet diversity, diet quality should be considered as important in understanding dietary risk factors for poor birth outcomes. Funding Sources This work has been supported by the National Institutes of Child Health and Human Development. Co-authors were supported by a grant from the National Institute of Child Health and Human Development and the National Institutes of Health.

Association of dietary diversity with uterine fibroids among urban premenopausal women in Shijiazhuang, China: A cross-sectional study.

Uterine fibroids (UFs) are the most common neoplasm affecting reproductive-age women. The purpose of the present study is to explore the association between dietary diversity and risk of UFs in a cross-sectional study of urban premenopausal women. A total of 248 urban premenopausal women with age of 20-45 were recruited in 3 randomly chosen hospitals in Shijiazhuang, China. Dietary diversity was assessed from food frequency intake data using dietary diversity score (DDS), Prime Diet Quality Score (PDQS) and food variety score (FVS). UFs were diagnosed by the methods of ultrasound, pelvic exam, or surgery. Binary logistic regression was used to estimate the relationship between dietary diversity and risk of UFs. 37 of the study subjects (14.9%) had UFs. Participants with a low education level and single marital status participants had a lower DDS and PDQS, respectively. After adjustment for confounding factors, a higher DDS 24 was associated with decreased UF risk (OR=0.22, 95% CI=0.05-1.01). Similar trends were observed for the plantbased FVS (ptrend=0.025). Carrot (OR=0.04, 95% CI=0.00-0.48) and kiwi fruit (OR=0.03, 95% CI=0.00-0.47) were also inversely associated with risk of UFs after adjustment for confounding factors. Multifarious food groups and the increase of variety of plant-based food, especially carrot and kiwi fruit, may be associated with the lower risk of UFs; they may play an important role in inhibiting the formation of UFs.

Demographic and socio-economic predictors of diet quality among adults in Bosnia and Herzegovina.

To evaluate associations of demographic and socio-economic factors with diet quality among population subgroups in Bosnia and Herzegovina (B&H). A cross-sectional analysis of 2017 B&H dietary survey data. Diet quality was assessed by the Prime Diet Quality Score (PDQS) utilizing data from two non-consecutive 24 h diet recalls. Socio-economic variables were extracted from the 2015 B&H Household Budget Survey. Homogeneity of means across population subgroups was evaluated using multivariable regression. B&H population survey. A population-based sample of 853 adults. The mean PDQS was 15·8 (range 7-28 out of a possible 42 points). In general, Bosnian adults had low PDQS due to high intakes of refined grains, high-fat dairy and processed meats, and low intakes of whole grains, nuts and fish. The PDQS was significantly higher (P < 0·0001) among older individuals (17·0) compared with those in the youngest group (14·5), among individuals living in the central and northern regions (16·5) compared with those living in the south (15·1; P < 0·0001), and among people who are married/cohabitating (16·1) v. single (14·8; P = 0·02). In energy-adjusted models, socio-economic status (P = 0·04) and tertiles of household spending (P = 0·002) were inversely associated with the PDQS. Diet quality in this population was low. Young and middle-aged individuals, singles and those living in the south had significantly lower quality diets compared with other subgroups. Public health action is needed to promote higher consumption of whole grains, nuts and fish, and a higher variety of fruits and vegetables.

Adherence to a priori dietary indexes and baseline prevalence of cardiovascular risk factors in the PREDIMED-Plus randomised trial.

Cardiovascular disease remains the global leading cause of death. We evaluated at baseline the association between the adherence to eight a priori high-quality dietary scores and the prevalence of individual and clustered cardiovascular risk factors (CVRF) in the PREDIMED-Plus cohort. All PREDIMED-Plus participants (6874 men and women aged 55-75years, with overweight/obesity and metabolic syndrome) were assessed. The prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidaemia), using standard diagnoses criteria, were considered as outcomes. The adherence to eight a priori-defined dietary indexes was calculated. Multivariable models were fitted to estimate differences in mean values of factors and prevalence ratios for individual and clustered CVRF. Highest conformity to any dietary pattern did not show inverse associations with hypertension. The modified Mediterranean Diet Score (PR = 0.95; 95% CI 0.90-0.99), Mediterranean Diet Adherence Score (MEDAS) (PR = 0.94; 95% CI 0.89-0.98), the pro-vegetarian dietary pattern (PR = 0.95; 95% CI 0.90-0.99) and the Alternate Healthy Eating Index 2010 (PR = 0.92; 95% CI 0.87-0.96) were inversely associated with prevalence of obesity. We identified significant inverse trend among participants who better adhered to the MEDAS and the Prime Diet Quality Score (PDQS)in the mean number of CVRF across categories of adherence. Better adherence to several high-quality dietary indexes was associated with better blood lipid profiles and anthropometric measures. Highest adherence to dietary quality indexes, especially Mediterranean-style and PDQS scores, showed marginal associations with lower prevalence of individual and clustered CVRF among elderly adults with metabolic syndrome at high risk of cardiovascular disease.

Evaluating pre-pregnancy dietary diversity vs. dietary quality scores as predictors of gestational diabetes and hypertensive disorders of pregnancy.

BackgroundDietary diversity scores (DDS) are considered as metrics for monitoring the implementation of the UN’s Sustainable Development Goals, but they need to be rigorously evaluated.ObjectiveTo examine two DDS, the Food Groups Index (FGI), and the Minimum Dietary Diversity-Women (MDD-W), alongside two dietary quality scores, the Alternate Healthy Eating Index (AHEI-2010) and the Prime Diet Quality Score (PDQS), with risks of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDPs).DesignThe analysis included 21,312 (GDM) and 19,917 (HDPs) singleton births reported in the Nurses’ Health Study II cohort (1991–2001), among women without major chronic disease or GDM/HDPs. Scores were derived using prepregnancy diet collected by a comprehensive food frequency questionnaire. Multivariable models were utilized to calculate relative risks (RR) and confidence intervals (95%CIs).ResultsIncident GDM (n = 916) and HDPs (n = 1,421) were reported. The MDD-W and FGI were not associated with risk of GDM or HDPs, but the AHEI-2010 and PDQS were associated with a lower risk of GDM and marginally lower risk of HDP. The RR’s of GDM comparing the highest vs. lowest quintiles were 1.00 (95%CI: 0.79, 1.27; p-trend = 0.82) for MDD-W, 0.96 (95%CI: 0.76, 1.22; p-trend = 0.88) for FGI, 0.63 (95%CI: 0.50, 0.81; p-trend <0.0001) for the AHEI-2010 and 0.68 (95%CI: 0.54, 0.86; p-trend = 0.003) for the PDQS. Similarly, the RR’s of HDPs were 0.92 (95%CI: 0.75, 1.12, p-trend = 0.94) for MDD-W, 0.97 (95%CI: 0.79, 1.17; p-trend = 0.83) for FGI, 0.84 (95%CI: 0.70, 1.02; p-trend = 0.07) for AHEI-2010 and 0.89 (95%CI: 0.74, 1.09; p-trend = 0.07) for PDQS.ConclusionsMDD-W and FGI did not predict the risk of GDM and HDPs. These DDS should not be widely used as metrics for achieving dietary goals in their present form. The Prime Diet Quality Score warrants further testing as a promising measure of a sustainable and healthy diet on a global scale.

International food group–based diet quality and risk of coronary heart disease in men and women

Standard diet quality assessment tools, which measure micronutrient sufficiency and food consumption related to disease and applicable to different populations, are needed to track progress in meeting the Sustainable Development Goals related to hunger, food security, and nutrition. Diet quality scores have been constructed for high- and low-income countries, but none are simple to administer or applicable internationally. We prospectively examined the association between the Food Group Index (FGI), the Minimal Diet Diversity Score for Women (MDDW), and a new Prime Diet Quality Score (PDQS), and the risk of ischemic heart disease (IHD) in 3 US cohorts. In total, 75,045 women (baseline age 43-63 y), 43,966 men (aged 40-75 y), and 93,131 younger women (aged 27-44 y) without a history of cardiovascular disease were followed up to 28 y. Diet was assessed multiple times using food frequency questionnaires and the 3 diet quality scores were computed for each individual. The association with IHD was modeled with Cox proportional hazard models, controlling for potential confounders. During follow-up, we ascertained 2908 incident IHD cases in the Nurses' Health Study, 3722 in the Health Professionals Follow-up Study, and 505 in the Nurses' Health Study II. The FGI was not associated with total IHD in any cohort. The PDQS was significantly associated with IHD in all 3 cohorts separately and the pooled RR for each SD increase was 0.89 (95% CI: 0.87, 0.91). This was significantly different than the pooled RR of 0.93 for MDDW (95% CI: 0.90, 0.96) and the RR of 0.98 for the FGI (95% CI: 0.95, 1.01). The association did not appear to differ by age. We found that the PDQS with the most detailed differentiation of healthy and unhealthy foods was associated with a lower risk of IHD in a high-income country. On the other hand, diet quality scores that do not account for unhealthy foods had a limited association with IHD.

International food group based diet quality and risk of coronary heart disease in men and women

BackgroundSimple diet quality scores have been constructed for low income countries to measure micronutrient adequacy. However, the utility of these scores in high‐income countries have not been examined with regard to clinical outcomes.ObjectiveWe prospectively examined the association between the Food Group Index (FGI), the Minimal Diet Diversity Score for Women (MDDW), and a newly constructed Prime Diet Quality Score (PDQS) and the risk of coronary heart disease in 3 U.S. cohorts.Methods75,055 women (baseline age 43–63), 41,506 men (aged 40–75), and 93,131 younger women (aged 27–44) without a history of cardiovascular disease were followed up to 28 years from 1984 to 2012. Diet was assessed up to 7 times using repeated food frequency questionnaires. The FGI comprised of 8 food groups, the MDDW 10, and the PDQS 21. We computed the 3 diet quality scores for each individual. The association with CHD was modeled with Cox proportional hazard model, controlling for potential confounders.ResultsDuring follow‐up, we ascertained 2,908 incident CHD in NHS, 3,547 in HPFS, and 505 in NHS II. The FGI was not associated with total CHD in any cohort while the MDDW was significantly but modestly associated with a lower risk of total CHD in NHS and HPFS (total CHD: RR one point increase = 0.95 for both NHS and HPFS, 95%CI=0.91–0.98 for NHS, 0.92–0.98 for HPFS). The PDQS was clearly and significantly associated with CHD in all 3 cohorts (RRs comparing top to bottom quintiles ranged from 0.63 in NHS II to 0.76 in NHS, lower bound of 95% CI ranged from 0.46 to 0.86, upper bound ranged from 0.84 to 0.86). The association did not differ by age.ConclusionWe found that the PDQS with the most detailed differentiation of healthy and unhealthy foods, was associated with a lower risk of CHD in a high income country. On the other hand, diet quality scores that do not account for unhealthy foods or have little gradation within each food group had limited (MDDW) or no (FGI) association with CHD.