Diet Quality Index associated with Digital Food Guide: update and validation

Abstract

Monitoring and assessing dietary intake may favor the promotion of healthy choices and the indexes that assess the quality of the diet contribute to this purpose. The Diet Quality Index associated with the Digital Food Guide (DQI-DFG) was developed from guidelines of the School of Public Health at Harvard University, adjusted for the Brazilian food habits. Based on new studies on prevention of chronic non-communicable diseases, the objective of this study was to improve and validate the DQI-DFG for a second version. The following psychometric properties were used: (a) content validation: consensus on healthy eating and DQI among experts; (b) construct validation: enhancement of a reference diet to determine recommended serving sizes and consumption ranges; correlation between each group score and energy value; comparative analyses between menu assessment by experts and DQI-DGF results to confirm the score criterion; (c) reliability: agreement between the result shown by the evaluators and the result presented by DQI-DFG; correlation between each food group score and total DQI score to understand the relationship between these variables. The energetic values do not influence the DQI score. There is a high correlation between the score attributed by experts and the result of DQI-DFG (r = 0.78 until r = 0.97). The Index components have a balanced score of influence in its final result (r = 0.49 until r = 0.10). Consensus result performed among experts legitimates the concepts that justify DQI-DFG. There was an agreement between menu quality evaluation by experts and the results shown by DQI-DFG.

A scoping review of approaches used to develop plant-based diet quality indices

“…Of the 137 included articles, 31 articles described the original development of 35 plant-based diet quality indices ( Table 1 [ [13] , [14] , [15] , 18 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] ] and Table 2 [ 15 , 18 , [40] , [41] , [42] , [43] , [45] , [46] , [47] , [48] , [49] , [51] , [52] , [53] , 55 ]), and the remaining 106 articles applied the 35 plant-based diet quality indices in an independent sample to the original development population ( Supplemental Table 2 ). The 137 included articles were published from 2007 to 2022, with most published in 2022 ( n = 39), 2021 ( n = 41), 2020 ( n = 20), and 2019 ( n = 11).…”

“… 0–130 Y, on the basis of recommendations from the DDG Diet Quality Index Associated to the Digital Food Guide (DQI-DFG) Caivano et al. 2019 Brazil [ 48 ] 1 ) Guidelines of the School of Public Health at Harvard University 2 ) Brazilian food habits 24-h recall 11 Moderation components: sugars and sweets, meats: beef, pork and processed meat, refined cereals, and processed fats Adequacy components: poultry, fish and eggs, whole cereals, tubers and roots, fruits, vegetables, legumes and oilseeds, milk and dairy products, and oils and fats All food groups scored a maximum of 5 or 10, on the basis of portion per 1,000 kcal. Dichotomous scoring for moderation components, where the maximum score was awarded for being within the recommended intake range or scored 0 when this range exceeded.…”

“…Across the 137 articles, 35 unique plant-based diet quality indices were reported. The indices were initially published in 31 articles between 2007 ( n = 2) [ 44 , 50 ] to 2022 ( n = 6) [ 43 , 44 , 48 , 53 , 57 , 67 ], but most were first published after 2017 ( n = 20) [ 13 , 41 , 42 , 46 , 48 , 49 , [52] , [53] , [54] , [55] , 57 , [60] , [61] , [62] , [63] , [65] , [66] , [67] , [68] , [69] ] ( Figure 2 and Table 1 ). The indices were mostly developed using populations from the US ( n = 13) [ 15 , [41] , [42] , [43] , 45 , 47 , 54 , 55 , 68 ], followed by the Netherlands ( n = 6) [ 13 , 18 , 48 , 53 , 61 , 69 ] and China ( n = 2) [ 54 , 63 , 65 , 66 ].…”

“…The indices were initially published in 31 articles between 2007 ( n = 2) [ 44 , 50 ] to 2022 ( n = 6) [ 43 , 44 , 48 , 53 , 57 , 67 ], but most were first published after 2017 ( n = 20) [ 13 , 41 , 42 , 46 , 48 , 49 , [52] , [53] , [54] , [55] , 57 , [60] , [61] , [62] , [63] , [65] , [66] , [67] , [68] , [69] ] ( Figure 2 and Table 1 ). The indices were mostly developed using populations from the US ( n = 13) [ 15 , [41] , [42] , [43] , 45 , 47 , 54 , 55 , 68 ], followed by the Netherlands ( n = 6) [ 13 , 18 , 48 , 53 , 61 , 69 ] and China ( n = 2) [ 54 , 63 , 65 , 66 ]. The sample sizes of the development studies ranged from 54 [ 47 ] to 212,142 [ 55 ], with almost all conducted in samples of men and women ( n = 32) [13,14,15,18, 41–50,52,53,55–63,65,68,69) ( Table 2 ).…”

“…The sample sizes of the development studies ranged from 54 [ 47 ] to 212,142 [ 55 ], with almost all conducted in samples of men and women ( n = 32) [13,14,15,18, 41–50,52,53,55–63,65,68,69) ( Table 2 ). About half of the indices ( n = 21) were developed using data from prospective cohort studies [ 13 , 14 , 15 , 18 , 41 , 42 , 46 , [51] , [52] , [53] , [54] , [55] , 59 , 60 , 62 , 63 , 68 ] followed by cross-sectional studies ( n = 9) [ 45 , [47] , [48] , [49] , [50] , 56 , 57 , 66 , 69 ].

FIGURE 2 Number of original plant-based diet quality indices published, and the number of publications applying them per year.

…”