Development of a lifestyle–diet quality index for primary schoolchildren and its relation to insulin resistance: the Healthy Lifestyle–Diet Index

Abstract

Objective: The aim of this work was to develop an index that evaluates the degree of adherence to existing dietary and lifestyle guidelines for primary school-aged children (Healthy Lifestyle-Diet Index (HLD-Index)) and examine its relationship with selected nutrient intake and insulin resistance (IR). Methods: Ten components were used to develop the HLD-Index. Scores from 0 to 4 were assigned to all components. The HLD-Index total score ranged between 0 and 40. A sample of 729 schoolchildren from Greece aged 10-12 years (The Healthy Growth Study) was used to evaluate the validation of the proposed index. Results: The overall mean ± standard deviation of the HLD-Index score was 20 ± 4.4. Higher HLD-Index scores were associated with lower proportion of children having intakes lower than Estimated Average Requirements by Institute of Medicine. On the basis of the cutoff point of 3.16 for homeostasis model assessment of IR, 20.9% of participants were found to be insulin resistant. After adjusting for potential confounders, logistic regression showed that a 1 unit increase in the score is associated with almost 8% lower odds for being insulin resistant. The cutoff point analysis revealed that score equal to or lower than 21 best discriminates children with IR from those without IR. On the basis of this cutoff point, the sensitivity of the HLD-Index was 70% and the corresponding specificity was 47%. Conclusions: The proposed HLD-Index could be used by public health policy makers and other health-care professionals to identify subgroups in the population with poor diet-lifestyle habits who are at increased probability for IR.

Revised Healthy Lifestyle‐Diet Index and associations with obesity and iron deficiency in schoolchildren: The Healthy Growth Study

“…As far as meat consumption was concerned, a score of 4 was assigned to a consumption frequency of two or three servings per week. The other components were scored in the same way as in the original HLD‐index (Manios et al ., ). More details for the scores assigned to each component are presented in Table .…”

“…The R‐HLD‐index resulted from the modification of the HLD‐index (Manios et al ., ), in an attempt to increase its applicability in the estimation of the degree of children's adherence to the most recent dietary and lifestyle guidelines. For the R‐HLD‐index, 12 components were used.…”

“…The study population comprised schoolchildren attending the fifth and sixth grades of primary schools located in municipalities within the wider regions of Attica, Aitoloakarnania, Thessaloniki and Heraklion. The sampling procedure has been described in detail previously (Moschonis et al, 2010). In brief, the sampling of schools was random, multistage and stratified by parental educational level and by the total population of students attending schools within these municipalities.…”

“…Moreover, lifestyle characteristics have not been included as components in any of the aforementioned indices. The authors of the present study have previously developed the Healthy Lifestyle‐Diet Index (HLD‐index) to evaluate the degree of adherence to existing dietary and lifestyle guidelines for primary schoolchildren based on the US Department of Agriculture (USDA)'s My Pyramid and reported negative associations with insulin resistance (Manios et al ., ). However, in the light of the USDA's ‘Choose My Plate’ (http://www.choosemyplate.gov) new dietary recommendations and the need to extend the applicability of this index to the evaluation of clinical conditions other than insulin resistance, further modifications of this index were necessary.…”

Newly derived children-based food index. An index that may detect childhood overweight and obesity

“…Few indexes have been designed specifically for children (Feskanich et al, 2004;Golley et al, 2011;Kleiser et al, 2009b;Kranz et al, 2006Kranz et al, , 2008Lazarou et al, 2009Lazarou et al, , 2011Manios et al, 2010;Serra-Majem et al, 2004), and according to our literature review, only three (3) indexes have been created for school aged children (Lazarou et al, 2011;Manios et al, 2010;Serra-Majem et al, 2004), only two (2) have been derived (Lazarou et al, 2011;Manios et al, 2015) with the main objective to detect risk for childhood OW and OB. These indexes, however, are either too complex (Lazarou et al, 2011) to be performed (many variables need to be determined, and nutrient calculation is required), or too simplified (Serra-Majem et al, 2004) using a very small scoring system increasing the risk for false results since small dietary variations cannot be detected.…”