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Measures of diet quality have evolved with a number of scoring indices currently in use. They are increasingly being used to examine epidemiological associations between dietary intake and nutrition-related health outcomes. The present review aims to describe current diet quality tools and their applications, and to examine the relationship between diet quality and morbidity and mortality. A search was conducted of MEDLINE, Cochrane, EMBASE, CINAHL and ProQuest electronic databases. Inclusion criteria were: English language; published from 2004 on; conducted in adult populations; longitudinal/cohort/case-control or cross-sectional study; included a theoretically defined measure of diet quality. A total of twenty-five indices of overall diet quality and/or variety were found, with components ranging from nutrients only to adherence to recommended food group servings, to variety within healthful food groups. The majority of studies reviewed had methodological weaknesses but demonstrated that higher dietary quality was consistently inversely related to all-cause mortality, with a protective effect of moderate magnitude. The associations were stronger for men and for all-cause and CVD mortality. The limitations of both the indices and the studies that use them need to be considered when interpreting and comparing results. However, diet quality indices do appear to be able to quantify risk of some health outcomes, including biomarkers of disease and risk of CVD, some cancers and mortality. Further research is needed to improve the validity of these tools and to adapt them for use in clinical dietetic practice.

To assess how well national sentinel lists of the most frequently consumed foods in each food group capture data at subnational levels to measure minimum diet diversity (MDD). We analysed data from seven surveys with 24-h open dietary recalls to evaluate: (1) the percentage of reported foods that were included in each sentinel food list; (2) whether these lists captured consumption of some food groups better than others and (3) differences between estimates of dietary diversity calculated from all food items mentioned in the open 24-h recall . only food items included in the sentinel lists. Seven subnational areas: Bangladesh (2), Benin, Colombia, Kenya, Malawi and Nepal. 8094 women 15-49 years; 4588 children 6-23 months. National sentinel food lists captured most foods reportedly consumed by women (84 %) and children (86 %). Food groups with the highest variability were 'other fruits' and 'other vegetables.' MDD calculated from the sentinel list was, on average, 6·5 (women) and 4·1 (children) percentage points lower than when calculated from open 24-h recalls, with a statistically significant difference in most subnational areas. National sentinel food lists can provide reliable data at subnational levels for most food groups, with some variability by country and sub-region. Assessing the accuracy of national sentinel food lists, especially for fruits and vegetables, before using them at the subnational level could avoid potentially underestimating dietary diversity and provide more accurate local information for programmes, policy and research.

Policies and programs often aim to improve the affordability of nutritious diets, but existing food price indexes are based on observed quantities that may not meet nutritional goals. To measure changes in the cost of reaching international standards of diet quality, we introduce a new cost of diet diversity index based on the lowest-cost way to include at least five different food groups as defined by the widely used minimum dietary diversity for women (MDD-W) indicator and compare that to a Cost of Nutrient Adequacy indicator for the lowest-cost way to meet estimated average requirements of essential nutrients and dietary energy. We demonstrate application of both indexes using national average monthly prices from two very different sources: an agricultural market information system in Ghana (2009–14) and the data used for national consumer price indexes in Tanzania (2011–15). We find that the cost of diet diversity index for Ghana fluctuated seasonally and since mid-2010 rose about 10% per year faster than national inflation, due to rising relative prices for fruit, which also drove up the cost of nutrient adequacy. In Tanzania there were much smaller changes in total daily costs, but more adjustment in the mix of food groups used for the least-cost diet. These methods can show where and when nutritious diets are increasingly (un)affordable, and which nutritional criteria account for the change. These results are based on monthly national average prices, but the method is generalizable to other contexts for monitoring, evaluation, and assessment of changing food environments.

Lebanon is undergoing a nutrition transition that increases the risk of nutritional deficiencies and noncommunicable diseases. This study assessed diet quality—measured by adherence to the Mediterranean diet (MD), household dietary diversity (HDD), and the dietary phytochemical index (DPI)—and examined its associations with sociodemographic factors and food insecurity (FI) among Lebanese adults. A cross-sectional survey was conducted from May to September 2022, involving a nationally representative sample of 444 adults aged 18–64 years. Participants were selected using a stratified cluster sampling technique across the eight Lebanese governorates. Data were collected through face-to-face anthropometric assessments and phone-based dietary and sociodemographic questionnaires. Dietary intake was assessed using a validated food frequency questionnaire (FFQ) and two non-consecutive 24-hour recalls. HDD was calculated using the Food Consumption Score (FCS), MD adherence was evaluated using the 14-MEDAS, and DPI was derived from the proportion of energy intake from phytochemical-rich foods. More than half of the participants (56.3%) had low HDD, 54.1% showed fair-to-very good adherence to the MD, and the mean DPI accounted for 22.25% of total energy intake. Being employed (aOR: 1.67; CI: 1.08–2.58) and having a university education (aOR: 3.29; CI: 1.95–5.54) predicted higher HDD, while FI reduced the odds (aOR: 0.42; CI: 0.27–0.65). FI (aOR: 1.63; CI: 1.11–2.38), female sex, and being unmarried were associated with greater MD adherence. Higher age, female sex, and being unmarried predicted a higher DPI, while household crowding reduced it. Findings reveal that Lebanese adults have low dietary diversity, moderate MD adherence, and low phytochemical intake. FI, sex, age, marital status, crowding, education, and employment significantly influenced diet quality. Notably, FI was associated with lower HDD but paradoxically with higher MD adherence. These results highlight the urgent need for systemic interventions to enhance diet quality and food security in Lebanon.

Groups with low socio-economic status have less healthy diets and higher prevalence of non-communicable diseases. Using the latest Swedish national dietary survey data, we developed a healthy eating index and a diet diversity score with the aim to explore associations between the scores and socio-demographic factors. Cross-sectional national dietary survey. A web-based retrospective registration of food and beverages during 2 d was used to assess dietary intake. This information was used to construct the Swedish Healthy Eating Index for Adolescents 2015 (SHEIA15) and the Riksmaten Adolescents Diet Diversity Score (RADDS). The scores were based on the latest Swedish dietary guidelines from 2015. Intakes of food and nutrients across the scores were examined. Mixed-effects multilevel models were used to assess associations between the scores and household education, sex, school grade, weight status and school municipality. School-based survey in Sweden. 2905 adolescents in grades 5, 8 and 11, 56 % girls. High scores on SHEIA15 and RADDS were associated with higher intake of vegetables, fish and several nutrients, and lower intake of sugar-sweetened beverages and red meat. Boys and participants in households with lower education level scored lower on both indices. Individuals with overweight/obesity scored lower on RADDS. The newly developed indices can be used to identify healthy eating patterns among Swedish adolescents. Both indices show that boys and adolescents from households with lower education level have poorer dietary habits. Lower diet diversity was related to overweight/obesity, but the overall healthy eating index was not.

Understanding species-specific resource requirements is paramount in managing and protecting biodiversity in a world where environmental quality is in decline. Dietary data can inform predator–prey relationships and how changes in prey availability impact different species. However, for many coral reef fishes, prey and predatory events can be difficult to observe and identify, both in situ and within examined stomach samples. Here we applied DNA metabarcoding of stomach content samples for 11 Red Sea butterflyfish species to identify the diversity of dietary components that these primarily benthic feeding fish consume across coral reefs. Detections based on 18S and COI sequences from partially digested stomach contents significantly increased the resolution and diversity of the known diet for this group of fish, which included cryptic prey that are difficult to visually document due to soft parts or morphological ambiguity. In addition to scleractinian corals and other Cnidaria, the obligate corallivore species fed on a wide range of benthic organisms, whereas facultative species displayed a broader diet with crustaceans, tunicates, and worms contributing to samples. While a number of individuals contained DNA that could not be confidently identified using this method, the proportion of unidentifiable sequences was relatively low across butterflyfish species. The COI marker identified the importance of soft corals in the diet for two hard coral specialists; Chaetodonmelannotus and Chaetodonsemilarvatus, with soft coral detected in over half of the individuals and contributing significantly to the number of DNA sequence reads within their gut. Notably, five prey items identified to the species level were detected that are currently not documented in the Red Sea. Our analysis revealed that the diet of different species of butterflyfish significantly overlaps, with all species deriving most of their diet from the phylum Cnidaria (hard and soft coral, anemones) and symbiotic Symbiodiniaceae algae. Furthermore, accumulation curves suggest that all study species may feed on an even greater fraction of the benthos, likely driven by the availability and diversity of each individual/pair’s territory. This approach increases the known dietary resolution and diversity of these key reef fishes and further enhances our understanding of the relationship between butterflyfish and benthic organisms.

This study aimed to assess diet quality score (DQS), considering healthy and unhealthy foods and nutrients, and diet diversity score (DDS) as indicators of risk of noncommunicable diseases in eight Latin American countries, and to verify the possible differences considering country, sex, age, socioeconomic, and nutritional status. A multicenter household population-based cross-sectional survey was conducted with 9218 individuals (age range 15–65 years). Sociodemographic and anthropometric data were collected. Dietary intake was measured using two non-consecutive 24-h recalls and diet quality and diversity were assessed. In the whole sample, scores were observed from 63.0% ± 9.3% to total DQS, 65.0% ± 13.6% to healthy dietary items and 60.2% ± 13.6% to unhealthy items, and 5.6 ± 1.1 out of 9 points to DDS. Women presented lower DDS compared to men (5.5 ± 1.1 vs. 5.6 ± 1.1, p < 0.001). Healthy DQS was higher as the socio-economic level increased, and unhealthy DQS was the opposite (p < 0.05). Total DQS was significantly lower only at the low socio-economic level (p < 0.05). Chile and Venezuela showed the lowest healthy (62.2 ± 15.2 and 61.9 ± 11.7, p < 0.05) and total DQS (61.4 ± 10.3, 61.2 ± 8.7, p < 0.05). No effects were observed when considering the age and anthropometric measurements. Promoting consumption of a diverse and high-quality diet is an essential challenge to accomplish.

Pollinators face many stressors, including reduced floral diversity. A low-diversity diet can impair organisms’ ability to cope with additional stressors, such as pathogens, by altering the gut microbiome and/or immune function, but these effects are understudied for most pollinators. We investigated the impact of pollen diet diversity on two ecologically and economically important generalist pollinators, the social bumble bee ( Bombus impatiens ) and the solitary alfalfa leafcutter bee ( Megachile rotundata ). We experimentally tested the effect of one-, two-, or three-species pollen diets on gut bacterial communities in both species, and the melanization immune response in B. impatiens . Pollen diets included dandelion ( Taraxacum officinale ), staghorn sumac ( Rhus typhina ), and hawthorn ( Crataegus sp.) alone, each pair-wise combination, or a mix of all three species. We fed bees their diet for 7 days and then dissected out guts and sequenced 16S rRNA gene amplicons to characterize gut bacterial communities. To assess melanization in B. impatiens , we inserted microfilament implants into the bee abdomen and measured melanin deposition on the implant. We found that pollen diet did not influence gut bacterial communities in M. rotundata. In B. impatiens , pollen diet composition, but not diversity, affected gut bacterial richness in older, but not newly-emerged bees. Pollen diet did not affect the melanization response in B. impatiens . Our results suggest that even a monofloral, low-quality pollen diet such as dandelion can support diverse gut bacterial communities in captive-reared adults of these bee species. These findings shed light on the effects of reduced diet diversity on bee health.

To determine whether food security, diet diversity and diet quality are associated with anthropometric measurements and body composition among women of reproductive age. The association between food security and anaemia prevalence was also tested. Secondary analysis of cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Food security and dietary data were collected by an interviewer-administered questionnaire. Hb levels were measured using a HemoCue, and anaemia was classified as an altitude-adjusted haemoglobin level < 12·5 g/dl. Body size and composition were assessed using anthropometry and dual-energy x-ray absorptiometry. The urban township of Soweto, Johannesburg, South Africa. Non-pregnant women aged 18-25 years (n 1534). Almost half of the women were overweight or obese (44 %), and 9 % were underweight. Almost a third of women were anaemic (30 %). The prevalence rates of anaemia and food insecurity were similar across BMI categories. Food insecure women had the least diverse diets, and food security was negatively associated with diet quality (food security category v. diet quality score: B = -0·35, 95 % CI -0·70, -0·01, P = 0·049). Significant univariate associations were observed between food security and total lean mass. However, there were no associations between food security and body size or composition variables in multivariate models. Our data indicate that food security is an important determinant of diet quality in this urban-poor, highly transitioned setting. Interventions to improve maternal and child nutrition should recognise both food security and the food environment as critical elements within their developmental phases.

Background This study explored the effects of Project Daire, a school-based food intervention, on secondary dietary outcomes Diet Diversity Score (DDS) and Diet Quality Score (DQS), among 6–7 and 10-11-year-old children. Methods A randomised-controlled, factorial design trial was conducted in 15 Northern Ireland primary schools across four intervention arms: Nourish, Engage, Nourish and Engage, and Control (Delayed). Nourish modified the school food environment and increased exposure to local foods, while Engage delivered educational activities on nutrition, food, and agriculture. Food consumption data were collected at baseline and at up to a 6-month follow-up. DDS and DQS (at home, at school and/or total) were determined based on the UK Eatwell Guide. Results A total of 445 children aged 6–7 and 458 aged 10–11 completed the trial. Among the 10-11-year-olds who received the Nourish intervention, significant increases were observed in the school DDS (adjusted mean difference = 2.79, 95% CI: 1.44–4.14; p  < 0.001) and total DDS (adjusted mean difference = 1.55, 95% CI: 0.65–2.44; p  = 0.001) compared to their counterparts who did not receive it. No such changes were observed in the DDS of 6-7-year-olds in the Nourish group, nor in either age group receiving the Engage intervention. The DQS of both age groups remained unchanged across all intervention groups. Conclusions The Nourish intervention was associated with improved dietary diversity among older children through modifications to the whole-school environment. However, the absence of measurable effects on diet quality highlights the need for future iterations of Project Daire to incorporate additional strategies. These should include targeted approaches to improve diet quality, foster active parental engagement, utilize validated dietary assessment tools, and ensure sustained implementation. Trial registration ClinicalTrials.gov Identifier: NCT04277312.