Development and evaluation of an index assessing adherence to the Norwegian food-based dietary guidelines: the Norwegian Dietary Guideline Index (NDGI).

BACKGROUND: Monitoring adherence to the Norwegian food-based dietary guidelines (FBDGs) could provide valuable insight into current and future diet-related health risks. This study aimed to develop and evaluate an index measuring adherence to the Norwegian FBDGs to be used as a compact tool in nutrition surveillance suitable for inclusion in large public health surveys. METHODS: The Norwegian Dietary Guideline Index (NDGI) was designed to reflect adherence to the Norwegian FBDGs on a scale from 0-100, with a higher score indicating better adherence. Dietary intakes were assessed through 19 questions, reflecting 15 dietary components covered by the Norwegian FBDGs. The NDGI was applied and evaluated using nationally representative dietary data from the cross-sectional web-based Norwegian Public Health Survey which included 8,558 adults.​ RESULTS: The population-weighted NDGI score followed a nearly normal distribution with a mean of 65 (SD 11) and range 21-99. Mean scores varied with background factors known to be associated with adherence to a healthy diet; women scored higher than men (67 vs. 64) and the score increased with age, with higher educational attainment (high 69 vs. low 64) and with better self-perceived household economy (good 67 vs. restricted 62). The NDGI captured a variety of dietary patterns that contributed to a healthy diet consistent with the FBDGs. CONCLUSION: The NDGI serve as a compact tool to assess and monitor adherence to the Norwegian FBDGs, to identify target groups for interventions, and to inform priorities in public health policies.​ The tool is flexible to adjustments and may be adaptable to use in other countries or settings with similar dietary guidelines.

The overlap of overweight and anaemia among women in three countries undergoing the nutrition transition.

OBJECTIVE: To compare the odds of anaemia in overweight and obese (OVWT) (body mass index (BMI) > or =25) versus non-overweight (non-OVWT) (BMI<25) women in three countries at different stages of the nutrition transition. DESIGN: Analysis of cross-sectional data. SETTING: Nationally representative data from Mexico (1998 National Nutrition Survey), Peru and Egypt (2000 Demographic and Health Surveys) were analyzed. SUBJECTS: Data from non-pregnant women ages 18-49 years were used. ANALYSIS: Logistic regression was used to test whether the odds of anaemia differed by BMI category, controlling for sociodemographic factors. RESULTS: More than half of the women were OVWT in all three countries and the prevalence of OVWT reached 77% in Egypt. Anaemia prevalence was similar across countries (28, 31 and 23% in Egypt, Peru and Mexico respectively). In Egypt, OVWT women had significantly lower odds of anaemia than non-OVWT women (OR=0.78, 95% CI: 0.68, 0.90). Similar results were found in Peru, but the difference was smaller in magnitude (OR=0.83, 95% CI: 0.71, 0.96). In Mexico, there were no differences in the odds of anaemia by BMI group. CONCLUSIONS: These findings show that the iron needs of OVWT women in developing countries are not necessarily being met. The intakes of other micronutrients might also be insufficient. Diet quality remains an important issue even among women with sufficient energy intakes.

Nutrient adequacy and dietary diversity in rural Mali: association and determinants.

OBJECTIVE: To examine the association between nutrient adequacy and dietary diversity, and to assess and compare the determinants for the two constructs in an adult population in rural Mali. DESIGN: Cross-sectional study assessing food intake by a validated 7-day quantitative food frequency questionnaire. Two different dietary diversity indexes were created: food variety score (FVS), a simple count of food items, and diet diversity score (DDS) a count of food groups. Mean adequacy ratio, the mean ratio of intake to recommended intake (each truncated at one) of energy and nine nutrients, was calculated as an indicator of nutrient adequacy. Information on household and individual characteristics, including demography, socioeconomic conditions and food production strategies was obtained using precoded questionnaires. SETTING: Bafoulabé district, Kayes region, Western Mali. SUBJECTS: In total, 502 subjects (55% women) aged 15-45 y from 319 different households. RESULTS: Both FVS and DDS had a positive correlation with mean adequacy ratio (MAR). Multivariate analysis (linear regression) showed that the most important factors explaining MAR was the number of milk products, vegetables and green leaves consumed, as well as sex and the number of crops produced in the household. Dietary diversity was associated with socioeconomic status, residence and age. CONCLUSION: Dietary diversity is useful as an indicator of nutrient adequacy. It is important to examine how various food groups contribute to the nutrient adequacy of the diet in an area.

Validation of food variety as an indicator of diet quality assessed with a food frequency questionnaire for Western Mali.

OBJECTIVE: To assess the validity of two diet quality indexes-food variety score (FVS) and diet diversity score (DDS) in Western Mali. DESIGN: In two separate studies (A and B), FVS and DDS were derived from a food frequency questionnaire (FFQ) and were compared with the same scores and with measures of nutrient adequacy derived from 2-day weighed records (WR). SETTING: Two rural, adjacent villages in Mali, West Africa. SUBJECTS: In study A (1996), 48 women and 27 men (15-59 y) participated. Study B (1999) included 34 women and 36 men (15-45 y). RESULTS: Spearman's correlation coefficients between FVS from the FFQ and WR for men were 0.5 in study A and 0.4 in study B. The corresponding correlations for DDS were 0.2 and 0.4, respectively. Correlations for women were lower, especially in study B. Classification into quartiles was also best for men. Correlations for the two diet variety scores from the FFQ with nutrient adequacy from the WR in study A were about 0.3 for men, but lower for women. In study B, these correlations were around 0.5 for men, whereas for women there was no association. CONCLUSION: FVS and DDS can be assessed by our FFQ. The two diet variety scores reflect diet quality and are simple tools that can be used for monitoring. The validation study gave better results for men than for women, which has implications for further use of these instruments.

Validation of a quantitative food-frequency questionnaire for use in Western Mali.

OBJECTIVE: The purpose of this study was to validate a quantitative food-frequency questionnaire (QFFQ) created for assessing the usual intake of foods and nutrients in the prevailing season in Western Mali. DESIGN: Intake of foods and nutrients over the week preceding the interview was measured with a 69-item QFFQ. Intakes were compared with intakes as measured with 2-day combined weighed and recalled diet records. SETTING: A rural village in Western Mali, West Africa. SUBJECTS: Twenty-seven men and 48 women (15-59 years of age) representing 18 households. RESULTS: Spearman rank correlations between intake of food groups from the QFFQ and the diet record ranged from 0.09 (meat/fish) to 0.58 (tea/coffee). Median coefficient was 0.37. Median Spearman correlation coefficient for nutrient intake was 0.40. Men had higher median correlation coefficients than did women. The proportion of subjects being classified into the same quartile of food intake was on median 33%, while a median of 7% was misclassified into extreme quartiles. Correct classification into the same quartile for intake of nutrients was on median 34% while a median of 4% was grossly misclassified. Intakes of most food groups and nutrients as measured by the QFFQ were higher than those measured by the diet records. However, while men had higher estimated intakes for foods eaten in-between meals, women in general had higher intake of foods eaten in the main meals. CONCLUSION: This QFFQ can be used for comparing the intake of foods and nutrients between groups within this study population. It therefore represents a useful tool in the surveillance of food intake in the population, both in identifying vulnerable groups and for tracking food intake over time. The differences between men and women in overestimating food intake need to be taken into account when using the method.

Food variety--a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa.

OBJECTIVE: This study assesses whether a simple count of food items and food groups can predict the nutritional adequacy of the diet in an economically poor country. DESIGN: A three-day weighed record of children. SETTING: Koutiala town, in Southeastern Mali. SUBJECTS: Seventy-seven children, 13-58 months of age. One child was excluded owing to an extraordinarily low food variety. INTERVENTION: The study was conducted in April August 1995. Data from this study were used to create two different indices: Food Variety Score (FVS), a simple count of food items, and Dietary Diversity Score (DDS), a count of food groups. Mean Adequacy Ratio (MAR) was calculated as an indicator for nutrient adequacy, and used to validate FVS and DDS. RESULTS: Mean (s.d.) FVS was 20.5 (3.8) and mean (s.d.) DDS was 5.8 (1.1). A positive correlation was found both between FVS and MAR (Pearson 0.33, P < 0.001) and DDS and MAR (Pearson 0.39, P < 0.001). With cut-off points for FVS at 23 and for DDS at 6, the indices have high ability to identify those with a nutritionally inadequate diet. MAR increased with increasing FVS and DDS. FVS needs to be at least 15 or DDS at least 5 to give a satisfactory MAR. CONCLUSION: Although a simple count of food items or food groups cannot give a full picture of the adequacy of the nutrient intake, the results from this study show that the food scores can give a fairly good assessment of the nutritional adequacy of the diet, particularly if combined. Such indicators are important for identification of vulnerable groups in areas where people normally eat from a shared bowl, which makes detailed dietary intake studies difficult, time consuming and expensive.