Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study

Abstract

The scientific community has become increasingly interested in the overall quality of diets rather than in single food-based or single nutrient-based approaches to examine diet–disease relationships. Despite the plethora of indices used to measure diet quality, there still exist questions as to which of these can best predict health outcomes. The present study aimed to compare the ability of five diet quality indices, namely the Recommendation Compliance Index (RCI), Diet Quality Index-International (DQI-I), Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet Score (MDS), and Dietary Inflammatory Index (DII), to detect changes in chronic disease risk biomarkers. Nutritional data from 1352 participants, aged 18–69 years, of the Luxembourg nationwide cross-sectional ORISCAV-LUX (Observation of Cardiovascular Risk Factors in Luxembourg) study, 2007–8, were used to calculate adherence to the diet quality index. General linear modelling was performed to assess trends in biomarkers according to adherence to different dietary patterns, after adjustment for age, sex, education level, smoking status, physical activity and energy intake. Among the five selected diet quality indices, the MDS exhibited the best ability to detect changes in numerous risk markers and was significantly associated with lower levels of LDL-cholesterol, apo B, diastolic blood pressure, renal function indicators (creatinine and uric acid) and liver enzymes (serum γ-glutamyl-transpeptidase and glutamate-pyruvate transaminase). Compared with other dietary patterns, higher adherence to the Mediterranean diet is associated with a favourable cardiometabolic, hepatic and renal risk profile. Diets congruent with current universally accepted guidelines may be insufficient to prevent chronic diseases. Clinicians and public health decision makers should be aware of needs to improve the current dietary guidelines.

The Mediterranean Diet Score Is More Strongly Associated with Favorable Cardiometabolic Risk Factors over 2 Years Than Other Diet Quality Indexes in Puerto Rican Adults

“…The authors suggested that differences in associations may have been due to particular consumption patterns and food components, particularly as most scores were originally developed in non-Hispanic white populations. Other studies have also reported sex-specific associations between diet scores and cardiometabolic outcomes (8,19,20); however, we did not test for interactions in this analysis.…”

“…Among Guatemalan young adults and 4 scores that were tested, only the Diet Quality Index-International was associated with BMI and waist circumference, and the Recommended Food Score was associated with TGs and glucose (19). Another study that compared 5 scores showed differential association with lipid markers, central obesity, and BP; the MeDS was more strongly associated with the outcomes (20). Using NHANES, Kant and Graubard (22) showed that the Recommended Food Score and a Dietary Diversity Score were more strongly associated with several biomarkers compared with the HEI.…”

“…with our longitudinal results. Alkerwi et al (20) suggested that reverse causality may be minimal if the population is relatively free of chronic disease, which is not the case for Puerto Ricans.…”

“…Other limitations of the MeDS are that it combines full-fat and low-fat dairy, combines all meat in one category (e.g., healthy lean meats as well as unfavorable processed meats), and includes fruit juices in the fruit category despite evidence that some types of juice may have adverse metabolic outcomes (39). Still, MeDSs are fairly easy to define, are suitable to measure diet quality and diet-disease associations (4), may better capture dietary variation in a population as related to cardiometabolic risk (20), and may have potential clinical applications when assessed by using quick screeners (40).…”

“…However, the composition, weight, and cutoffs of intake of the foods and nutrients included in each score vary widely (4,11), suggesting that their association with disease outcomes may also vary. Studies that have directly contrasted scores have been inconsistent; some show that all scores predict death, risk of diabetes (12)(13)(14) and cardiovascular disease (CVD) (13,(15)(16)(17), or weight changes (18) with comparable magnitude of association, whereas others show larger differences in the association of various scores and cardiometabolic markers within a population (19)(20)(21)(22).…”