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Background: New tools for monitoring diets, such as the Diet Quality Questionnaire (DQQ), may help reduce the costs and burden associated with traditional methods of diet assessment. However, its proposed sentinel foods require validation in target populations. This study aimed to validate the Chilean sentinel foods and describe the performance of DQQ, as well as its Global Dietary Recommendation (GDR) indicators, in two Chilean cohorts. Methods: We analyzed dietary data from 1418 pregnant women and 799 children using 24 h recalls. Foods and beverages were classified and ranked into 29 DQQ food groups. Food items that accounted for more than 95% of the total consumption within each of the 29 food groups were selected and identified as sentinels. We estimated the proportion of consumers in each food group and calculated the indicators, as well as their relationship with the consumption of ultra-processed foods (UPFs). Results: The pregnant women had a mean age of 29.1 (SD 6.6), and the children had a mean age of 6.2 (SD 0.5). The sentinel foods of six groups (grain-based sweets, other sweets, salty snacks, deep-fried food, and sweet tea/coffee/cocoa) captured under 95% of the group’s total consumption. The pregnant women had a higher frequency of consumption of staple and healthy foods, and the mean GDR score was 9.3 (SD 2.20). The children had higher consumption of unhealthy food groups, and the mean GDR score was 8.1 (SD 2.05). The GDR-protect scores showed a moderate but statistically significant negative correlation with ultra-processed food consumption (p-value < 0.0001). Conclusions: The DQQ is a suitable tool for collecting dietary data to estimate diet quality using food group-based indicators. Additionally, it is possible to identify different dietary patterns at a crucial stage of life, such as childhood and pregnancy. However, it requires some adaptations of sentinel foods and further testing on other populations before it can be implemented to monitor Chilean diets.

Specific nutrients or dietary patterns influence an individual’s psychological stress. As a major aspect of a healthy diet, the influence of dietary diversity on psychological stress remains uncertain. Within these contexts, we aimed to examine the association between the dietary diversity score and psychological stress, using prospective data from the China Health and Nutrition Survey (CHNS). We included 7434 adult participants, with complete dietary information, in the 2011 wave, and followed-up with perceived stress scale (PSS-14) in the 2015 wave. The dietary intake of foods was coded into 29 food groups, using the DQQ for China, and the dietary diversity scores were obtained, using DQQ, by calculating the number of food groups consumed during one 24-h dietary recall. The univariate analysis, and logistic regression model were used to examine the relationship between psychological stress and diet diversity. Approximately half of the participants (4204, 56.55%) perceived a higher level of stress (PSS-14 total score > 25). Dietary diversity was lower in the higher-stress group (p for trend <0.0001). Unconditional multivariate logistic regression demonstrated that participants with higher daily dietary diversity were less likely to experience higher-level psychological stress, compared with participants with lower daily dietary diversity (ORs range: 0.480–0.809). Dietary diversity was found to be inversely associated with psychological stress, in this prospective analysis of a national population. Further studies are required to figure out the mechanism and effectiveness of dietary diversity on psychological stress.

Dietary quality is of great significance to human health at all country income levels. However, low-cost and simple methods for population-level assessment and monitoring of diet quality are scarce. Within these contexts, our study aimed to identify the sentinel foods nationally and by province of 29 food groups to adapt the diet quality questionnaire (DQQ) for China, and validate the effectiveness of the DQQ using data from the China Health and Nutrition Survey (CHNS). The DQQ is a rapid dietary assessment tool with qualitative and quantitative analysis to determine appropriate sentinel foods to represent each of 29 food groups. Dietary data of 13,076 participants aged 15 years or older were obtained from wave 2011 of CHNS, and each food and non-alcoholic beverage was grouped into 29 food groups of the DQQ. The data were analyzed to determine the most commonly consumed food items in each food group, nationally and in each province. Key informant interviews of 25 individuals familiar with diets in diverse provinces were also conducted to identify food items that may be more common in specific provinces. China’s DQQ was finalized based on identification of sentinel foods from the key informant interviews, and initial national results of the quantitative data. Consumption of sentinel foods accounted for over 95% of people who consumed any food item in each food group, at national levels and in all provinces for almost all food groups, indicating the reliability of the sentinel food approach. Food-group consumption data can be obtained through DQQ to analyze dietary diversity as well as compliance with WHO global dietary guidance on healthy diets, providing a low-burden, food-group-based and simple method for China to evaluate diet quality at the whole population level.

Purpose Diet plays a fundamental role in promoting resilience against stress-related disorders. We aimed to examine the overall and sex-specific association between food groups and perceived stress in adults. Methods We analyzed the prospective data of 7,434 adults who completed both the 2011 and 2015 surveys of the China Health and Nutrition Survey (CHNS). The Diet Quality Questionnaire (DQQ) was used to code all the food items of 2011 dietary intake into 29 food groups, and perceived stress in 2015 was measured using a 14-item perceived stress scale (PSS-14). Univariate analysis and logistic regression models were used to examine the relationship between food groups and perceived stress. Results People who perceived a higher level of stress (PSS-14 total score > 25) made up 41.5% and 45.1% of the male and female groups, respectively (χ 2  = 9.605, p  = 0.002). Individuals with increased intake of food groups such as legumes, other vegetables, other fruits, yogurt, poultry, fish & seafood, fluid milk, and fruit juice were less likely to experience a higher level of psychological stress (OR range: 0.544–0.892, p  < 0.05). Additionally, we found sex-specific associations between food groups and perceived stress. The difference in the proportion of food groups, such as fluid milk and fish & seafood, between the two stress groups in men was statistically significant ( p  < 0.025). In the female group, the distribution of eight food groups, like legumes and nuts & seeds, between the two stress groups was statistically significant ( p  < 0.025). Conclusion This study indicated that food groups were differentially associated with perceived stress.

The low-burden Diet Quality Questionnaire (DQQ) has been developed to rapidly assess diet quality globally. Poor diet is often correlated with body size, and certain dietary risk factors can result in overweight and obesity. We aimed to examine the extent to which the DQQ captured food group consumption among children and adolescents in China, and to understand the association of several new indicators of diet quality scores derived from the DQQ with overweight and obesity, using the 2011 wave of the China Health and Nutrition Survey. The DQQ questions are constructed using sentinel foods—that is, food items that are intended to capture a large proportion of the population consuming the food groups. The overall Global Dietary Recommendations (GDR) score, GDR-Healthy score, and GDR-Limit score are novel indicators of diet quality that reflect dietary risk factors for non-communicable diseases derived from the DQQ questions. Multivariable logistic regression analysis was used to examine the associations of the GDR scores with overweight and obesity in the sample. The DQQ questions captured over 95% of children who consumed the food groups. Additionally, we found that the GDR-Limit score was positively associated with general obesity (odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.17–1.74) and abdominal obesity (OR = 1.22, 95% CI: 1.05–1.43), whereas the overall GDR score was negatively related to general obesity (OR = 0.85, 95% CI: 0.74–0.97). The low-burden DQQ could be a valid tool to assess diet quality for the Chinese pediatric population aged 7–18 years. Poor diet quality, as determined by the GDR-Limit score, is associated with the increased risk of obesity in Chinese children and adolescents.

Background Minimum Dietary Diversity for Women (MDD-W) has been identified as a promising indicator for monitoring diets globally. MDD-W questionnaires have been integrated into, amongst others, the Demographic and Health Surveys (DHS) and the Gallup World Poll (GWP). Disagreement between estimates of healthy diet metrics for the same country collected in the same year is not desirable. Objectives To determine the measurement agreement of MDD-W estimates collected through DHS and GWP (i.e., precision), to assess the impact of survey characteristics on potential discordance, and to examine the comparative validity of the brief data collection instruments used to estimate MDD-W (i.e., accuracy). Methods Using meta-data from DHS and GWP, we quantified the percentage points (pp) difference in food group consumption and MDD-W prevalence. Furthermore, we qualitatively examined the differences of four survey characteristics: food groups and sentinel foods used in the MDD-W questionnaire, sampling framework, survey timing, and data collection modality. In addition, using data from two non-inferiority studies in Ethiopia – which used either a weighed food record (WFR) or quantitative 24-hour recall (24-HR) as the reference method – we simulated the total magnitude of errors associated with non-quantitative open or list-based 24-HRs, and subsequently compared the pp differences in simulated food group consumption and MDD-W prevalence. Results MDD-W estimates from the GWP were significantly higher than those from the DHS in five of nine country-year sets, one difference was non-significant, and three estimates could not be statistically compared due to lack of reporting on margins of error. The absolute difference between MDD-W estimates from the DHS and GWP were >|5| pp for all country-year sets (range: -17 to + 21 pp). There was poor agreement between the DHS and GWP questionnaires regarding the choice and number of sentinel foods used for each food group in the same country (range: 21 to 65%). In general, GWP data collection covered fewer months and questionnaires were enumerated in fewer languages than the DHS, but the number of sentinel foods used per food group was more standardized across countries. Simulations indicated that the magnitude of errors associated with pilot tested non-quantitative open and extensive list-based 24-HRs were marginally lower than sentinel list-based 24-HRs in Ethiopia. Conclusion For global monitoring, standards must be defined for the preferred data collection instrument and survey platform for each healthy diet metric. This would facilitate cross-country comparability and help mitigate misinterpretations of change over time within countries and the selective reporting of national statistics. A harmonized methodology for developing, pilot testing, and continuously updating sentinel food lists is needed to further improve the accuracy of MDD-W questionnaires.

The aim of this study was to explore the associations between diet quality, socio-demographic measures, smoking, and weight status in a large, cross-sectional cohort of adults living in Yorkshire and Humber, UK. Data from 43, 023 participants aged over 16 years in the Yorkshire Health Survey, 2nd wave (2013–2015) were collected on diet quality, socio-demographic measures, smoking, and weight status. Diet quality was assessed using a brief, validated tool. Associations between these variables were assessed using multiple regression methods. Split-sample cross-validation was utilised to establish model portability. Observed patterns in the sample showed that the greatest substantive differences in diet quality were between females and males (3.94 points; P < 0.001) and non-smokers vs smokers (4.24 points; P < 0.001), with higher diet quality scores observed in females and non-smokers. Deprivation, employment status, age, and weight status categories were also associated with diet quality. Greater diet quality scores were observed in those with lower levels of deprivation, those engaged in sedentary occupations, older people, and those in a healthy weight category. Cross-validation procedures revealed that the model exhibited good transferability properties. Inequalities in patterns of diet quality in the cohort were consistent with those indicated by the findings of other observational studies. The findings indicate population subgroups that are at higher risk of dietary-related ill health due to poor quality diet and provide evidence for the design of targeted national policy and interventions to prevent dietary-related ill health in these groups. The findings support further research exploring inequalities in diet quality in the population.

There is increasing evidence that adherence to a Mediterranean dietary pattern reduces the incidence of diet-related diseases. To date, the habitual dietary intake of New Zealand (NZ) adults has not been examined in relation to its alignment with a Mediterranean-style dietary pattern. This study aimed to define the habitual dietary patterns, nutrient intakes, and adherence to the Mediterranean Diet in a sample of 1012 NZ adults (86% female, mean age 48 ± 16 years) who had their diabetes risk defined by the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Dietary intakes were collected using a validated semi-quantitative NZ food frequency questionnaire, and dietary patterns were identified using principal component analysis. Reported intakes from the FFQ were used in conjunction with the Mediterranean-Style Dietary Pattern Score (MSDPS) to determine adherence to a Mediterranean dietary pattern. Mixed linear models were used to analyze the association between dietary patterns and MSDPS with demographics, health factors, and nutrient intakes. Two distinct dietary patterns were identified: Discretionary (positive loadings on processed meat, meat/poultry, fast food, sweet drinks, and sugar, sweets, and baked good) and Guideline (positive loadings on vegetables, eggs/beans, and fruits). Adherence to dietary patterns and diet quality was associated with age and ethnicity. Dietary patterns were also associated with sex. Adherence to a Mediterranean dietary pattern defined by the MSDPS was low, indicating that a significant shift in food choices will be required if the Mediterranean Diet is to be adopted in the NZ population.

Poor diet quality has been shown to increase the risk of common chronic diseases that can negatively impact quality of life and burden the healthcare system. Canada's Food Guide evidence-based recommendations provide dietary guidance aimed at increasing diet quality. Compliance with Canada's Food Guide can be assessed with the Canadian Healthy Eating Index (C-HEI), a diet quality score. The recently designed Canadian Diet History Questionnaire II (C-DHQ II), a comprehensive food frequency questionnaire could be used to estimate the C-HEI in Canadian populations with the addition of food group equivalents (representing Canada's Food Guide servings) to the C-DHQ II nutrient database. We describe methods developed to augment the C-DHQ II nutrient database to estimate the C-HEI. Food group equivalents were created using food and nutrient data from existing published food and nutrient databases (e.g. the Canadian Community Health Survey - Cycle 2.2 Nutrition [2004]). The variables were then added to the C-DHQ II companion nutrient database. C-HEI scores were determined and descriptive analyses conducted for participants who completed the C-DHQ II in a cross-sectional Canadian study. The mean (standard deviation) C-HEI score in this sample of 446 adults aged 20 to 83 was 64.4 (10.8). Women, non-smokers, and those with more than high school education had statistically significant higher C-HEI scores than men, smokers and those with high school diplomas or less. The ability to assess C-HEI using the C-DHQ II facilitates the study of diet quality and health outcomes in Canada.

This study provides comprehensive validation of the 14-item Mediterranean Diet Adherence Screener (14-MEDAS) in an adult population from Greece (GR), Portugal (PT), Italy (IT), Spain (SP), Cyprus (CY), Republic of North Macedonia (NMK), and Bulgaria (BG). A moderate association between the 14-MEDAS and the reference food diary was estimated for the entire population (Pearson r = 0.573, p-value < 0.001; Intraclass Correlation Coefficient (ICC) = 0.692, p-value < 0.001) with the strongest correlation found in GR, followed by PT, IT, SP, and CY. These results were supported by kappa statistics in GR, PT, IT, and SP with ≥50% of food items exhibiting a fair or better agreement. Bland–Altman analyses showed an overestimation of the 14-MEDAS score in the whole population (0.79 ± 1.81, 95%Confidence Interval (CI) 0.61, 0.96), but this value was variable across countries, with GR, NMK, and BG exhibiting the lowest bias. Taking all analyses together, the validation achieved slightly better results in the Mediterranean countries but a definitive validation ranking order was not evident. Considering growing evidence of the shift from Mediterranean Diet (MD) adherence and of the importance of culture in making food choices it is crucial that we further improve validation protocols with specific applications to measure and compare MD adherence across countries and to relate it to the health status of a specific population.