Development and Validation of the Global Diet Quality Score (GDQS) for Children 24 to 59 Months of Age

Abstract

Objectives: To develop the Global Diet Quality Score (GDQS) for children aged 24-59 months and evaluate its performance in predicting outcomes related to nutrient adequacy and diet-related noncommunicable disease (NCD) risk. Background: The GDQS is a food-based metric developed and validated for capturing diets’ contributions to nutrient adequacy and NCD risk among adult men and nonpregnant and nonlactating women aged ≥15 years globally. Despite the importance of ensuring healthy diets in preschool children and the need for systematic monitoring, no food-based metrics exist that holistically measure diet quality among children aged 24-59 months in diverse populations. Methods: We developed candidate versions of the GDQS for children aged 24-59 months by adapting the gram cutoff values used for adults to account for children’s lower energy requirements. Using dietary data sets from Bangladesh, Burkina Faso, China, Ethiopia, Mexico, the United Kingdom, and the United States, we evaluated candidate versions’ performance in predicting energy-adjusted nutrient intakes and adequacy, nutritional biomarkers, and overweight using Spearman’s correlation and multivariable-adjusted regression models, and we statistically compared performance of the strongest candidate with that of the Minimum Dietary Diversity–Women (MDD-W) indicator and Global Dietary Recommendations (GDR) score. Results: The GDQS exhibited significant (P < .05) positive correlations with energy-adjusted intakes of protein, fiber, and most micronutrients in most data sets; significant negative correlations with added sugar and saturated fat in 2 data sets; and inconsistent correlations with monounsaturated and polyunsaturated fat. In multivariable-adjusted models, the GDQS, MDD-W, and GDR were positively associated with serum folate in Ethiopia (and the GDQS was in the United Kingdom), and the GDR was positively associated with high-density lipoprotein cholesterol in China (P < .05). The GDQS was more strongly associated with the mean probability of adequacy of 8 nutrients than the GDR in 2 data sets, whereas the MDD-W outperformed the GDQS in 3 data sets (P < .05). Conclusion: The GDQS is a useful metric for measuring diet quality among children aged 24-59 months in diverse populations.