New metric helps researchers determine who is at higher risk for malnutrition and noncommunicable diseases
Poor diet quality, a major driver of both malnutrition and noncommunicable diseases, was responsible for 22% of adult deaths in 2017. Until recently, however, no simple global standard metric existed for monitoring diet quality among various populations and population subgroups that could help pinpoint who might be at higher risk for malnutrition and noncommunicable disease.
In response, a group of nutrition scientists recently developed an easy-to-use metric, the Global Diet Quality Score, for gathering and analyzing diet quality data in a broad range of settings, under the auspices of Intake, a Center for Dietary Assessment. Intake, whose leadership team includes several ASN members, seeks to “fill the gap in the availability of actionable information on diets through providing technical assistance for the planning, design, collection, analysis, and use of dietary data.”
The Global Diet Quality Score is based on the intake of 25 food groups. Points accrue for higher intake of healthy food groups and lower intake of unhealthy groups. Although the Global Diet Quality Score was developed using data from nonpregnant, nonlactating women of reproductive age in low- and middle-income countries, the authors stressed the metric “ideally would also be applicable to other demographic groups and high-income countries.”
Published as a Supplement to The Journal of Nutrition, “The Global Diet Quality Score (GDQS): A New Method to Collect and Analyze Population-Based Data on Diet Quality” features 11 articles that detail both the development of this novel tool as well as its application across countries in Asia, Africa, and North America, offering researchers the information they need to apply the Global Diet Quality Score to their own population-level studies.
The initial development and testing of the Global Diet Quality Score is detailed in the Supplement’s introductory article, “Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS).” Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in ten African countries as well as in China, India, Mexico, and the United States, ASN member Sabri Bromage and colleagues detailed how they conducted secondary analyses to develop the Global Diet Quality Score. They then evaluated how this metric correlated with nutrient adequacy, anthropometry, biomarkers, and type 2 diabetes, among other outcomes. Moreover, the authors compared the performance of the Global Diet Quality Score to that of existing metrics.
In “Application of the Global Diet Quality Score in Chinese Adults to Evaluate the Double Burden of Nutrient Inadequacy and Metabolic Syndrome,” Yuna He and colleagues described how they calculated Global Diet Quality Scores, working with food intake data from 35,146 men and women aged 18 years and over who participated in the 2010-2012 China National Nutrition and Health Survey. These scores, in turn, were applied to determine the prevalence of double burden, defined as coexisting metabolic syndrome and nutrient inadequacy.
According to the authors, a lower Global Diet Quality Score was associated with a higher incidence of nutrient inadequacy and metabolic syndrome across various subgroups of Chinese adults. The authors noted, “the finding supports the use of the Global Diet Quality Score in different demographic groups of Chinese adults to assess diet quality and nutritional status.”
ASN member Teresa T. Fung and colleagues set out to test the ability of the Global Diet Quality Score to predict the risk of type 2 diabetes among women in the United States, publishing their results in “Higher Global Diet Quality Score Is Inversely Associated with Risk of Type 2 Diabetes in US Women.” The authors worked with data collected from 88,520 women aged 27 to 44 years at baseline who had participated in the Nurses’ Health Study II.
According to the study findings, a lower Global Diet Quality Score was associated with a higher incidence of type 2 diabetes in both reproductive-age women and women over 50 years of age in the United States. The authors noted that the Global Diet Quality Score “performed well compared with the Alternate Healthy Eating Index-2010 in predicting diabetes risk.” In particular, the authors noted how, in comparison to the Alternative Healthy Eating Index, “our results showed that lower intake of unhealthy foods appeared to be more important than higher intake of healthy foods.”
In short, according to Sabri Bromage and colleagues, “the simplicity of the Global Diet Quality Score and its ability to capture both nutrient adequacy and diet-related noncommunicable disease risk render it a promising candidate for global monitoring platforms.”