Validation of the Global Diet Quality Score (GDQS) Among Children 10 to 14 Years of Age

Abstract

Objective: We aimed to evaluate the performance of the Global Diet Quality Score (GDQS) in predicting nutrient intake and health outcomes among children aged 10–14 years old in Mexico, the United States, the United Kingdom, and China. For comparison, we evaluated other dietary metrics (Minimum Dietary Diversity for Women [MDD-W], the Global Dietary Recommendations score [GDR], and the Healthy Eating Index–2020 [HEI-2020]). Background: Given the magnitude of the health burden associated with all forms of malnutrition, monitoring dietary quality is fundamental to improving global health. Early adolescence is a key stage of development, and thus validated tools to measure diet quality that are pertinent for the global context are needed. Methods: The GDQS and comparison metrics were estimated from 24-hour dietary recalls (Mexico: n ¼ 2533; United States: n ¼ 685; China: n ¼ 1087, and United Kingdom: n ¼ 1675). Regression models were conducted to evaluate the association between the change in 1 SD of each metric score and usual intake of nutrients, mean probability of nutrient adequacy, and biomarker and anthropometric outcomes adjusted by age, sex, socioeconomic status, educational level, urban/rural area, and usual energy intake (for dietary outcomes). Results: The GDQS showed a higher diet quality in China (16.7 points) and Mexico (15.9 points), followed by the United States (13.6 points) and the United Kingdom (12.2 points). The GDQS was found to be associated with the intake of micronutrients as well as noncommunicable disease (NCD)–related nutrients (fiber, added sugar, and saturated fat) (P < .05). The performance of the GDQS was comparable to all other metrics; yet, in the case of NCD-related nutrients the MDD-W was slightly inferior. Few associations were found across countries and metrics with biomarker and anthropometric outcomes. Conclusion: The GDQS was associated with the intake of micronutrients and NCD-related nutrients; these results suggest that the GDQS is an appropriate tool to monitor dietary quality among 10–14-year-olds across several contexts globally.