Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 165
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Assmann, Karen E. Andreeva, Valentina A. Camilleri, Géraldine M. Verger, Eric O. Jeandel, Claude Hercberg, Serge Galan, Pilar and Kesse-Guyot, Emmanuelle 2016. Dietary scores at midlife and healthy ageing in a French prospective cohort. British Journal of Nutrition, Vol. 116, Issue. 04, p. 666.

    Backholer, Kathryn Spencer, Elizabeth Gearon, Emma Magliano, Dianna J McNaughton, Sarah A Shaw, Jonathan E and Peeters, Anna 2016. The association between socio-economic position and diet quality in Australian adults. Public Health Nutrition, Vol. 19, Issue. 03, p. 477.

    Burggraf, Christine Teuber, Ramona and Glauben, Thomas 2016. Dietary quality as a non-medical health input: a theoretical approach to analyse the demand for dietary quality. European Review of Agricultural Economics, p. jbv040.

    Chan, Ruth Leung, Jason and Woo, Jean 2016. A Prospective Cohort Study to Examine the Association Between Dietary Patterns and Sarcopenia in Chinese Community-Dwelling Older People in Hong Kong. Journal of the American Medical Directors Association, Vol. 17, Issue. 4, p. 336.

    Chen, Danhong Jaenicke, Edward C. and Volpe, Richard J. 2016. Food Environments and Obesity: Household Diet Expenditure Versus Food Deserts. American Journal of Public Health, Vol. 106, Issue. 5, p. 881.

    Collins, Laura J. Lacy, Kathleen E. Campbell, Karen J. and McNaughton, Sarah A. 2016. The Predictors of Diet Quality among Australian Children Aged 3.5 Years. Journal of the Academy of Nutrition and Dietetics, Vol. 116, Issue. 7, p. 1114.

    Eloranta, A.M. Schwab, U. Venäläinen, T. Kiiskinen, S. Lakka, H.M. Laaksonen, D.E. Lakka, T.A. and Lindi, V. 2016. Dietary quality indices in relation to cardiometabolic risk among Finnish children aged 6–8 years – The PANIC study. Nutrition, Metabolism and Cardiovascular Diseases,

    Gorgulho, B. M. Pot, G. K. Sarti, F. M. and Marchioni, D. M. 2016. Indices for the assessment of nutritional quality of meals: a systematic review. British Journal of Nutrition, Vol. 115, Issue. 11, p. 2017.

    Gougeon, Laura 2016. Dietary Patterns and Depression in Community-Dwelling Older Adults: State of the Evidence. Current Nutrition Reports, Vol. 5, Issue. 2, p. 106.

    Jessri, Mahsa Nishi, Stephanie K. and L’Abbe, Mary R. 2016. Assessing the nutritional quality of diets of Canadian children and adolescents using the 2014 Health Canada Surveillance Tool Tier System. BMC Public Health, Vol. 16, Issue. 1,

    Julia, Chantal Méjean, Caroline Touvier, Mathilde Péneau, Sandrine Lassale, Camille Ducrot, Pauline Hercberg, Serge and Kesse-Guyot, Emmanuelle 2016. Validation of the FSA nutrient profiling system dietary index in French adults—findings from SUVIMAX study. European Journal of Nutrition, Vol. 55, Issue. 5, p. 1901.

    Kesse-Guyot, Emmanuelle Assmann, Karen E. Andreeva, Valentina A. Touvier, Mathilde Neufcourt, Lola Shivappa, Nitin Hébert, James R. Wirth, Michael D. Hercberg, Serge Galan, Pilar and Julia, Chantal 2016. Long-term association between the dietary inflammatory index and cognitive functioning: findings from the SU.VI.MAX study. European Journal of Nutrition,

    Mandalazi, Emmanuel Drake, Isabel Wirfält, Elisabet Orho-Melander, Marju and Sonestedt, Emily 2016. A High Diet Quality Based on Dietary Recommendations Is Not Associated with Lower Incidence of Type 2 Diabetes in the Malmö Diet and Cancer Cohort. International Journal of Molecular Sciences, Vol. 17, Issue. 6, p. 901.

    Maukonen, Mirkka Kanerva, Noora Partonen, Timo Kronholm, Erkki Konttinen, Hanna Wennman, Heini and Männistö, Satu 2016. The associations between chronotype, a healthy diet and obesity. Chronobiology International, p. 1.

    Mendes, Aline Pereira, Jaqueline Lopes Fisberg, Regina Mara and Marchioni, Dirce Maria Lobo 2016. Dietary energy density was associated with diet quality in Brazilian adults and older adults. Appetite, Vol. 97, p. 120.

    Okubo, Hitomi Miyake, Yoshihiro Sasaki, Satoshi Tanaka, Keiko and Hirota, Yoshio 2016. Early sugar-sweetened beverage consumption frequency is associated with poor quality of later food and nutrient intake patterns among Japanese young children: the Osaka Maternal and Child Health Study. Nutrition Research, Vol. 36, Issue. 6, p. 594.

    Roy, Rajshri Hebden, Lana Rangan, Anna and Allman-Farinelli, Margaret 2016. The development, application, and validation of a Healthy eating index for Australian Adults (HEIFA—2013). Nutrition, Vol. 32, Issue. 4, p. 432.

    Steffen, Lyn M. and Hootman, Katie C. 2016. A Posteriori Data-Derived Dietary Patterns and Incident Coronary Heart Disease: Making Sense of Inconsistent Findings. Current Nutrition Reports,

    Thorpe, Maree Milte, Catherine Crawford, David and McNaughton, Sarah 2016. A Revised Australian Dietary Guideline Index and Its Association with Key Sociodemographic Factors, Health Behaviors and Body Mass Index in Peri-Retirement Aged Adults. Nutrients, Vol. 8, Issue. 3, p. 160.

    Thorpe, Maree G. Milte, Catherine M. Crawford, David and McNaughton, Sarah A. 2016. A comparison of the dietary patterns derived by principal component analysis and cluster analysis in older Australians. International Journal of Behavioral Nutrition and Physical Activity, Vol. 13, Issue. 1,


A critical review of predefined diet quality scores

  • Patricia M. C. M. Waijers (a1), Edith J. M. Feskens (a1) and Marga C. Ocké (a1)
  • DOI:
  • Published online: 01 February 2007

The literature on predefined indexes of overall diet quality is reviewed. Their association with nutrient adequacy and health outcome is considered, but our primary interest is in the make-up of the scores. In total, twenty different indexes have been reviewed, four of which have gained most attention, and many others were based on those four. The various scores differ in many respects, such as the items included, the cut-off values used, and the exact method of scoring, indicating that many arbitrary choices have been made. Correlations in intake between dietary components may not be adequately addressed. In general, diet quality scores show an association with mortality or disease risk, but these relations are generally modest. Existing indexes do not predict morbidity or mortality significantly better than individual dietary factors. Although conclusions from the review may provide guidance in the construction of a diet quality score, it is questionable whether a dietary score can be obtained that is a much better predictor of health outcome.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      A critical review of predefined diet quality scores
      Your Kindle email address
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      A critical review of predefined diet quality scores
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      A critical review of predefined diet quality scores
      Available formats
Corresponding author
*Marga Ocké, fax +31 30 2744466;
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

MA Bernstein , KL Tucker , ND Ryan , EF O'Neill , KM Clements , ME Nelson , WJ Evans & MA Fiatarone Singh (2002) Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc 102, 10961104.

CS Brennan (2005) Dietary fibre, glycaemic response, and diabetes. Mol Nutr Food Res 49, 560570.

JK Chan , BE McDonald , JM Gerrard , VM Bruce , BJ Weaver & BJ Holub (1993) Effect of dietary alpha-linolenic acid and its ratio to linoleic acid on platelet and plasma fatty acids and thrombogenesis. Lipids 28, 811817.

HK Choi , WC Willett , MJ Stampfer , E Rimm & FB Hu (2005) Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study. Arch Intern Med 165, 9971003.

M de Lorgeril , P Salen , JL Martin , I Monjaud , P Boucher & N Mamelle (1998) Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Arch Intern Med 158, 11811187.

M de Lorgeril , P Salen , JL Martin , I Monjaud , J Delaye & N Mamelle (1999) Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 99, 779785.

A Drewnowski , SA Henderson , A Driscoll & BJ Rolls (1997) The Dietary Variety Score: assessing diet quality in healthy young and older adults. J Am Diet Assoc 97, 266271.

A Drewnowski , SA Henderson , AB Shore , C Fischler , P Preziosi & S Hercberg (1996) Diet quality and dietary diversity in France: implications for the French paradox. J Am Diet Assoc 96, 663669.

L Dubois , M Girard & N Bergeron (2000) The choice of a diet quality indicator to evaluate the nutritional health of populations. Public Health Nutr 3, 357365.

E Fernandez , E Negri , C La Vecchia & S Franceschi (2000) Diet diversity and colorectal cancer. Prev Med 31, 1114.

MJ Gerber , JD Scali , A Michaud , MD Durand , CM Astre , J Dallongeville & MM Romon (2000) Profiles of a healthful diet and its relationship to biomarkers in a population sample from Mediterranean southern France. J Am Diet Assoc 100, 11641171.

PS Haines , AM Siega-Riz & BM Popkin (1999) The Diet Quality Index revised: a measurement instrument for populations. J Am Diet Assoc 99, 697704.

A Haveman-Nies , LP de Groot , J Burema , JA Cruz , M Osler & WA van Staveren (2002) Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study. Am J Epidemiol 156, 962968.

A Haveman-Nies , KL Tucker , LC de Groot , PW Wilson & WA van Staveren (2001) Evaluation of dietary quality in relationship to nutritional and lifestyle factors in elderly people of the US Framingham Heart Study and the European SENECA study. Eur J Clin Nutr 55, 870880.

FB Hu (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13, 39.

FB Hu , JE Manson & WC Willett (2001) Types of dietary fat and risk of coronary heart disease: a critical review. J Am Coll Nutr 20, 519.

P Huijbregts , E Feskens , L Rasanen , F Fidanza , A Nissinen , A Menotti & D Kromhout (1997a) Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ 315, 1317.

PP Huijbregts , EJ Feskens , L Rasanen , F Fidanza , A Alberti-Fidanza , A Nissinen , S Giampaoli & D Kromhout (1998) Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands. Eur J Clin Nutr 52, 826831.

KJ Joshipura , A Ascherio , JE Manson , MJ Stampfer , EB Rimm , FE Speizer , CH Hennekens , D Spiegelman & WC Willett (1999) Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 282, 12331239.

KJ Joshipura , FB Hu , JE Manson , (2001) The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 134, 11061114.

AK Kant (1996) Indexes of overall diet quality: a review. J Am Diet Assoc 96, 785791.

AK Kant (2004) Dietary patterns and health outcomes. J Am Diet Assoc 104, 615635.

AK Kant , A Schatzkin , BI Graubard & C Schairer (2000) A prospective study of diet quality and mortality in women. JAMA 283, 21092115.

AK Kant & FE Thompson (1997) Measures of overall diet quality from a food frequency questionnaire: National Health Interview Survey, 1992. Nutr Res 17, 14431456.

ET Kennedy , SA Bowman , JT Spence , M Freedman & J King (2001) Popular diets: correlation to health, nutrition, and obesity. J Am Diet Assoc 101, 411420.

ET Kennedy , J Ohls , S Carlson & K Fleming (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.

DE King (2005) Dietary fiber, inflammation, and cardiovascular disease. Mol Nutr Food Res 49, 594600.

KT Knoops , LC de Groot , D Kromhout , AE Perrin , O Moreiras-Varela , A Menotti & WA van Staveren (2004) Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292, 14331439.

C La Vecchia , SE Munoz , C Braga , E Fernandez & A Decarli (1997) Diet diversity and gastric cancer. Int J Cancer 72, 255257.

MRH Lowik , KFAM Hulshof & JH Brussaard (1999) Food-based dietary guidelines: some assumptions tested for the Netherlands. Br J Nutr 81, s143s149.

M Massari , KM Freeman , F Seccareccia , A Menotti & G Farchi (2004) An index to measure the association between dietary patterns and coronary heart disease risk factors: findings from two Italian studies. Prev Med 39, 841847.

KB Michels & A Wolk (2002) A prospective study of variety of healthy foods and mortality in women. Int J Epidemiol 31, 847854.

PK Newby & KL Tucker (2004) Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev 62, 177203.

K Oh , FB Hu , JE Manson , MJ Stampfer & WC Willett (2005) Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. Am J Epidemiol 161, 672679.

M Osler , BL Heitmann , LU Gerdes , LM Jorgensen & M Schroll (2001) Dietary patterns and mortality in Danish men and women: a prospective observational study. Br J Nutr 85, 219225.

M Osler , A Helms Andreasen , B Heitmann , S Hoidrup , U Gerdes , L Morch Jorgensen & M Schroll (2002) Food intake patterns and risk of coronary heart disease: a prospective cohort study examining the use of traditional scoring techniques. Eur J Clin Nutr 56, 568574.

M Osler & M Schroll (1997) Diet and mortality in a cohort of elderly people in a north European community. Int J Epidemiol 26, 155159.

RE Patterson , PS Haines & BM Popkin (1994) Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 94, 5764.

MA Pereira , DR Jacobs Jr, L Van Horn , ML Slattery , AI Kartashov & DS Ludwig (2002) Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA 287, 20812209.

J Scali , A Richard & M Gerber (2001) Diet profiles in a population sample from Mediterranean southern France. Public Health Nutr 4, 173182.

JD Seymour , EE Calle , EW Flagg , RJ Coates , ES Ford & MJ Thun (2003) Diet Quality Index as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort. Am J Epidemiol 157, 980988.

ML Slattery , TD Berry , J Potter & B Caan (1997) Diet diversity, diet composition, and risk of colon cancer (United States). Cancer Causes Control 8, 872882.

V Solfrizzi , A D'Introno , AM Colacicco , C Capurso , R Palasciano , S Capurso , F Torres , A Capurso & F Panza (2005) Unsaturated fatty acids intake and all-causes mortality: a 8·5-year follow-up of the Italian Longitudinal Study on Aging. Exp Gerontol 40, 335343.

A Trichopoulou , C Bamia & D Trichopoulos (2005a) Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 165, 929935.

A Trichopoulou , T Costacou , C Bamia & D Trichopoulos (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.

A Trichopoulou , A Kouris-Blazos , ML Wahlqvist , C Gnardellis , P Lagiou , E Polychronopoulos , T Vassilakou , L Lipworth & D Trichopoulos (1995) Diet and overall survival in elderly people. BMJ 311, 14571460.

A Trichopoulou , P Orfanos , T Norat , (2005b) Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 330, 991996.

SJ Weinstein , TM Vogt & SA Gerrior (2004) Healthy Eating Index scores are associated with blood nutrient concentrations in the third National Health And Nutrition Examination Survey. J Am Diet Assoc 104, 576584.

W Willett (1998) Nutritional Epidemiology, 2nd ed. New York: Oxford University Press.

J Woo , KS Woo , SS Leung , (2001) The Mediterranean score of dietary habits in Chinese populations in four different geographical areas. Eur J Clin Nutr 55, 215220.

MB Zemel & SL Miller (2004) Dietary calcium and dairy modulation of adiposity and obesity risk. Nutr Rev 62, 125131.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *