Formation and Validation of the Healthy Diet Index (HDI) for Evaluation of Diet Quality in Healthcare

Abstract

Lack of tools to evaluate the quality of diet impedes dietary counselling in healthcare. We constructed a scoring for a validated food intake questionnaire, to measure the adherence to a healthy diet that prevents type 2 diabetes (T2D). The Healthy Diet Index (HDI) consists of seven weighted domains (meal pattern, grains, fruit and vegetables, fats, fish and meat, dairy, snacks and treats). We studied the correlations of the HDI with nutrient intakes calculated from 7-day food records among 52 men and 25 women, and associations of HDI with biomarkers and anthropometrics among 645 men and 2455 women. The HDI correlated inversely with total fat (Pearson’s r = −0.37), saturated fat (r = −0.37), monounsaturated fat (r = −0.37), and the glycaemic index of diet (r = −0.32) and positively with carbohydrates (r = 0.23), protein (r = 0.25), fibre (r = 0.66), magnesium (r = 0.26), iron (r = 0.25), and vitamin D (r = 0.27), (p < 0.05 for all). In the linear regression model adjusted for BMI and age, HDI is associated inversely with waist circumference, concentrations of fasting and 2-h glucose and triglycerides in men and women, total and LDL cholesterol in women, and fasting insulin in men (p < 0.05 for all). The HDI proved to be a valid tool to measure adherence to a health-promoting diet and to support individualised dietary counselling.

Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial

“…Obesity was defined as BMI ≥30 kg/m 2 , and abdominal obesity was defined as a waist circumference ≥88 cm for women and ≥102 cm for men [23]. Diet quality was assessed using the Healthy Diet Index that ranges between 0 and 100, and is calculated as the sum of scores for 7 main domains, including meal pattern (0-10 points), grains (0-20 points), fruits and vegetables (0-20 points), fats (0-15 points), fish and meat (0-10 points), dairy (0-10 points), and snacks and treats (0-15 points), with higher scores indicating a healthier diet [24]. Perceived self-efficacy related to nutrition was measured with the Nutrition Emotional Barriers Self-Efficacy Score, with higher scores indicating better emotional barrier self-efficacy [25].…”

Real-world effectiveness of digital and group-based lifestyle interventions as compared with usual care to reduce type 2 diabetes risk – A stop diabetes pragmatic randomised trial

“…The primary outcomes were one-year changes in diet quality assessed by the Healthy Diet Index (HDI) 18 total physical activity, body weight, fasting plasma glucose, and 2-hour plasma glucose from the 2-hour OGTT. The HDI gives an estimate of the adherence to a healthy diet according to the Nordic and Finnish nutrition recommendations, with emphasis on dietary factors associated with the risk of T2D.…”

Associations between weight loss history and factors related to type 2 diabetes risk in the Stop Diabetes study

“…Dietary intake was measured using an 18-item food intake questionnaire within the StopDia digital questionnaire. Healthy Diet Index (HDI), which has been developed and validated based on this 18item questionnaire for assessing diet quality as compared to the Nordic Nutrition Recommendations was computed [32,47]. HDI consists of seven weighted domains: meal pattern, grains, fruit and vegetables, fats, fish and meat, dairy, and snacks and treats.…”

“…The total HDI score gives a comprehensive measure for diet quality based on the sum score of these domains. It ranges from 0 to 100, with a higher score indicating a better diet quality [47].…”