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In recent years, methods for measuring diet quality have evolved and a number of scoring systems or indices to this effect have emerged. This relatively new concept involves the assessment of both quality and variety of the entire diet, enabling examination of associations between whole foods and health status, rather than just nutrients. Diet quality is measured by scoring food patterns in terms of how closely they align with national dietary guidelines and how diverse the variety of healthy choices is within core food groups or equivalent international groupings. More refined scoring methods allow both protective dietary patterns and unfavourable intakes to be identified. As diet quality and variety scores have been examined in association with health outcomes cross-sectionally and to predict such outcomes longitudinally, nutrition interventions could potentially be developed to target improvements in the most critical aspects of an individual's or population's food intake; for example, targeting an increase in fruit and vegetable consumption if an index shows a strong relationship between low intake and CVD.
Kant has previously published two reviews of diet quality indices(1,2), indicating a need for additional validation studies to assess the effectiveness of these indices in predicting nutritional and health status. Thus the aims of the present review were to:
1.
Describe current diet quality tools and their applications.
2.
Analyse whether higher diet quality scores are associated with lower levels of morbidity and mortality.
3.
Examine how robust the studies of association between diet quality and morbidity and mortality are in relation to their findings.
Methods
Search strategy for identification of studies
A systematic review of published English-language literature from 2004 to 2007 was conducted. Relevant literature prior to this time was identified from the reviews previously published by Kant(1,2).
The following electronic databases were searched: MEDLINE, Cochrane, EMBASE (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and ProQuest. Scopus was used to identify studies that had cited Kant's 2004 review(2). The MeSH (Medical Subject Headings of the National Library of Medicine) keyword search terms included diet, dietary, quality, variety, diversity, pattern, score, indicator, index, guideline, Healthy Eating Index, Alternative Healthy...