饮食质量差是典型营养不良和非传染性疾病(NCD)的主要驱动因素,并导致2017年22%的成人死亡。大多数国家面临营养不足和非传染性疾病的双重负担,然而,在人群和人群亚组中,没有简单的全球标准指标来监测饮食质量。
我们的目标是开发一个易于使用的指标,用于营养充足和饮食相关的NCD风险在不同的环境。
使用来自非孕妇的横截面和队列数据,10个非洲国家和中国的育龄妇女,印度,墨西哥,和美国,我们进行了二次分析,以开发饮食质量的新指标,并评估指标与营养素摄入量和充足性之间的关联,人体测量学,生物标志物,2型糖尿病,以及迭代修改的度量设计,以提高性能,并将新颖的度量性能与现有度量进行比较。
我们制定了全球饮食质量评分(GDQS),以食物为基础的指标,包含比大多数现有饮食指标更全面的食物组列表,和简单的方法来计算消耗的数量。在二级分析中,GDQS与最低膳食多样性-女性指标在预测膳食蛋白质的能量调整总量方面的表现相当,纤维,钙,铁,锌,维生素A,叶酸,和维生素B12充足,并与人体测量和生化指标的营养不良(包括体重不足,贫血,和血清叶酸缺乏),GDQS在捕捉NCD相关结果方面也表现得与2010年替代健康饮食指数相当或更好(包括代谢综合征,体重和腰围的变化,和2型糖尿病事件)。
GDQS的简单性及其捕获营养充足性和饮食相关NCD风险的能力使其成为全球监测平台的有希望的候选者。有必要进行研究以验证在人口调查中实施GDQS评估的方法,包括作为该项目的一部分开发的基于应用程序的新型24小时召回系统。
Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups.
We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings.
Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as
China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics.
We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes).
The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application-based 24-h recall system developed as part of this project.