Skip to main content Accessibility help
×
Home

Development and evaluation of the US Healthy Food Diversity index

  • Maya Vadiveloo (a1), L. Beth Dixon (a2), Tod Mijanovich (a3), Brian Elbel (a4) (a5) and Niyati Parekh (a4) (a6)...

Abstract

Varied diets are diverse with respect to diet quality, and existing dietary variety indices do not capture this heterogeneity. We developed and evaluated the multidimensional US Healthy Food Diversity (HFD) index, which measures dietary variety, dietary quality and proportionality according to the 2010 Dietary Guidelines for Americans (DGA). In the present study, two 24 h dietary recalls from the 2003–6 National Health and Nutrition Examination Survey (NHANES) were used to estimate the intake of twenty-six food groups and health weights for each food group were informed by the 2010 DGA. The US HFD index can range between 0 (poor) and 1 − 1/n, where n is the number of foods; the score is maximised by consuming a variety of foods in proportions recommended by the 2010 DGA. Energy-adjusted Pearson's correlations were computed between the US HFD index and each food group and the probability of adequacy for fifteen nutrients. Linear regression was run to test whether the index differentiated between subpopulations with differences in dietary quality commonly reported in the literature. The observed mean index score was 0·36, indicating that participants did not consume a variety of healthful foods. The index positively correlated with nutrient-dense foods including whole grains, fruits, orange vegetables and low-fat dairy (r 0·12 to 0·64) and negatively correlated with added sugars and lean meats (r − 0·14 to − 0·23). The index also positively correlated with the mean probability of nutrient adequacy (r 0·41; P< 0·0001) and identified non-smokers, women and older adults as subpopulations with better dietary qualities. The US HFD index may be used to inform national dietary guidance and investigate whether healthful dietary variety promotes weight control.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org 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. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ 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.

      Development and evaluation of the US Healthy Food Diversity index
      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 <service> account. Find out more about sending content to Dropbox.

      Development and evaluation of the US Healthy Food Diversity index
      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 <service> account. Find out more about sending content to Google Drive.

      Development and evaluation of the US Healthy Food Diversity index
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: Dr N. Parekh, fax +1 212 998 4194, email niyati.parekh@nyu.edu

References

Hide All
1 Dixon, LB, Cronin, FJ & Krebs-Smith, SM (2001) Let the pyramid guide your food choices: capturing the total diet concept. J Nutr 131, 461S472S.
2 Murphy, SP, Foote, JA, Wilkens, LR, et al. (2006) Simple measures of dietary variety are associated with improved dietary quality. J Am Diet Assoc 106, 425429.
3 Kant, AK, Schatzkin, A, Harris, TB, et al. (1993) Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr 57, 434440.
4 Kant, AK & Graubard, BI (2005) A comparison of three dietary pattern indexes for predicting biomarkers of diet and disease. J Am Coll Nutr 24, 294303.
5 Mirmiran, P, Azadbakht, L, Esmaillzadeh, A, et al. (2004) Dietary diversity score in adolescents – a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study. Asia Pac J Clin Nutr 13, 5660.
6 Kant, AK, Block, G, Schatzkin, A, et al. (1991) Dietary diversity in the US population, NHANES II, 1976–1980. J Am Diet Assoc 91, 15261531.
7 Kennedy, E (2004) Dietary diversity, diet quality, and body weight regulation. Nutr Rev 62, S78S81.
8 De Lorenzo, A, Deurenberg, P, Pietrantuono, M, et al. (2003) How fat is obese? Acta Diabetol 40, Suppl. 1, S254S257.
9 Azadbakht, L, Mirmiran, P, Esmaillzadeh, A, et al. (2006) Dietary diversity score and cardiovascular risk factors in Tehranian adults. Public Health Nutr 9, 728736.
10 Vadiveloo, M, Dixon, LB & Parekh, N (2013) Associations between dietary variety and measures of body adiposity: a systematic review of epidemiological studies. Br J Nutr 109, 15571572.
11 Putnam, J & Allshouse, J (1999) Food consumption, prices, and expenditures, 1970–97. In US Department of Agriculture Statistical Bulletin no. 965 . Washington, DC: Government Printing Office.
12 Remick, AK, Polivy, J & Pliner, P (2009) Internal and external moderators of the effect of variety on food intake. Psychol Bull 135, 434451.
13 Jekanowski, MD & Binkley, JK (2000) Food purchase diversity across U.S. markets. Agribusiness 16, 417433.
14 Moss, M (2013) Salt Sugar Fat: How the Food Giants Hooked us United States. New York: Random House.
15 Raynor, HA & Epstein, LH (2001) Dietary variety, energy regulation, and obesity. Psychol Bull 127, 325341.
16 Hill, AJ (2007) The psychology of food craving. Proc Nutr Soc 66, 277285.
17 Drewnowski, A, Henderson, SA, Driscoll, A, et al. (1997) The Dietary Variety Score: assessing diet quality in healthy young and older adults. J Am Diet Assoc 97, 266271.
18 McCrory, MA, Fuss, PJ, McCallum, JE, et al. (1999) Dietary variety within food groups: association with energy intake and body fatness in men and women. Am J Clin Nutr 69, 440447.
19 Roberts, SB, Hajduk, CL, Howarth, NC, et al. (2005) Dietary variety predicts low body mass index and inadequate macronutrient and micronutrient intakes in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 60, 613621.
20 Ruel, MT (2003) Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr 133, 3911S3926S.
21 U.S. Department of Agriculture & U.S. Department of Health and Human Services (2010) Dietary Guidelines for Americans, 2010, 7th ed. Washington, DC: U.S. Government Printing Office.
22 Drescher, LS, Thiele, S & Mensink, GB (2007) A new index to measure healthy food diversity better reflects a healthy diet than traditional measures. J Nutr 137, 647651.
23 Guenther, PM, Reedy, J, Krebs-Smith, SM, et al. (2008) Evaluation of the Healthy Eating Index-2005. J Am Diet Assoc 108, 18541864.
24 Subar, AF, Harlan, LC & Mattson, ME (1990) Food and nutrient intake differences between smokers and non-smokers in the US. Am J Public Health 80, 13231329.
25 Dallongeville, J, Marécaux, N, Fruchart, J-C, et al. (1998) Cigarette smoking is associated with unhealthy patterns of nutrient intake: a meta-analysis. J Nutr 128, 14501457.
26 Hiza, HA, Casavale, KO, Guenther, PM, et al. (2013) Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet 113, 297306.
27 Dwyer, J, Picciano, MF & Raiten, DJ (2003) Collection of food and dietary supplement intake data: What We Eat in America – NHANES. J Nutr 133, 590S600S.
28 National Center for Health Statistics & Centers for Disease Control and Prevention (2006) Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES). Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention.
29 Breslow, RA, Guenther, PM, Juan, W, et al. (2010) Alcoholic beverage consumption, nutrient intakes, and diet quality in the US adult population, 1999–2006. J Am Diet Assoc 110, 551562.
30 Dixon, LB, Sundquist, J & Winkleby, M (2000) Differences in energy, nutrient, and food intakes in a US sample of Mexican-American women and men: findings from the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol 152, 548557.
31 Vernarelli, JA & Lambert, JD (2013) Tea consumption is inversely associated with weight status and other markers for metabolic syndrome in US adults. Eur J Nutr 52, 10391048.
32 Centers for Disease Control and Prevention & National Center for Health Statistics (2006) NHANES 2003–2004 Data Documentation, Codebook, and Frequencies: Smoking and Tobacco Use. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/SMQ_C.htm (accessed accessed 6 February 2014).
33 Centers for Disease Control and Prevention & National Center for Health Statistics (2008) NHANES 2005–2006 Data Documentation, Codebook, and Frequencies. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/SMQ_D.htm (accessed accessed 6 February 2014).
34 Centers for Disease Control and Prevention & National Center for Health Statistics (2006) NHANES 2003–2004 Data Documentation, Codebook, and Frequencies: Dietary Interview-Individual Foods. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/DR1IFF_C.htm (updated November 2007 and accessed 6 February 2014).
35 Centers for Disease Control and Prevention & National Center for Health Statistics (2008) NHANES 2005–2006 Data Documentation, Codebook, and Frequencies: Dietary Interview. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/DRXDOC_D.htm (accessed accessed 6 February 2014).
36 National Center for Health Statistics and Centers for Disease Control (2008) NHANES 2003–2004 Data Documentation, Codebook, and Frequencies: Food Frequency Questionnaire – Output from DietCalc Software (FFQDC_C). Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/FFQDC_C.htm (accessed accessed 6 February 2014).
37 National Center for Health Statistics and Centers for Disease Control (2008) NHANES 2005–2006 Data Documentation, Codebook, and Frequencies: Food Frequency Questionnaire – Output from DietCalc Software (FFQDC_D). Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/FFQDC_D.htm (accessed accessed 6 February 2014).
38 Berry, CH (1971) Corporate growth and diversification. J Law Econ 14, 371383.
39 U.S. Department of Agriculture & Dietary Guidelines Advisory Committee (2010) Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: U.S. Department of Agriculture, Agricultural Research Service.
40 United States Department of Agriculture & Agricultural Research Service (2012) USDA National Nutrient Database for Standard Reference, Release 25. Washington, DC: U.S. Department of Agriculture, Agricultural Research Service. http://ndb.nal.usda.gov/ (updated 7 December 2011 and accessed 6 February 2014).
41 Bowman, SA, Friday, JE & Moshfegh, A (2008) MyPyramid Equivalents Database, 2.0 for USDA Survey Foods, 2003–2004 [Online]. Beltsville, MD: Food Surveys Research Group, Beltsville Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture.
42 National Cancer Institute (2008) Usual Dietary Intakes: Details of the Method. Bethesda, MD: National Cancer Institute, National Institutes of Health, and Department of Health and Human Services. http://riskfactor.cancer.gov/diet/usualintakes/details.html (updated February 2008 and accessed 6 February 2014).
43 Kipnis, V, Midthune, D, Buckman, DW, et al. (2009) Modeling data with excess zeros and measurement error: application to evaluating relationships between episodically consumed foods and health outcomes. Biometrics 65, 10031010.
44 Palaniappan, U, Cue, RI, Payette, H, et al. (2003) Implications of day-to-day variability on measurements of usual food and nutrient intakes. J Nutr 133, 232235.
45 Foote, JA, Murphy, SP, Wilkens, LR, et al. (2004) Dietary variety increases the probability of nutrient adequacy among adults. J Nutr 134, 17791785.
46 Mirmiran, P, Azadbakht, L & Azizi, F (2006) Dietary diversity within food groups: an indicator of specific nutrient adequacy in Tehranian women. J Am Coll Nutr 25, 354361.
47 Verger, EO, Mariotti, F, Holmes, BA, et al. (2012) Evaluation of a diet quality index based on the probability of adequate nutrient intake (PANDiet) using national French and US dietary surveys. PLOS ONE 7, e42155.
48 Centers for Disease Control and Prevention & National Center for Health Statistics (2007) 2003–2004 Data Documentation, Codebook, and Frequencies: Dietary Interview – Total Nutrients, First Day. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/DR1TOT_C.htm (accessed accessed 6 February 2014).
49 Centers for Disease Control and Prevention, National Center for Health Statistics (2008) 2005–2006 Data Documentation, Codebook, and Frequencies: Dietary Interview – Total Nutrient Intakes, First Day. Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics. http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/DR1TOT_D.htm (accessed accessed 6 February 2014).
50 National Academy of Sciences (2006) Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. 560 p. [Otten, JJ, Hellwig, JP, Meyers, LD, editors]. Washington, DC: National Academies Press.
51 Barr, SI, Murphy, SP & Poos, MI (2002) Interpreting and using the dietary references intakes in dietary assessment of individuals and groups. J Am Diet Assoc 102, 780788.
52 Folsom, AR, Parker, ED & Harnack, LJ (2007) Degree of concordance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease. Am J Hypertens 20, 225232.
53 Cotton, PA, Subar, AF, Friday, JE, et al. (2004) Dietary sources of nutrients among US adults, 1994 to 1996. J Am Diet Assoc 104, 921930.
54 Sommer, A & Vyas, KS (2012) A global clinical view on vitamin A and carotenoids. Am J Clin Nutr 96, 1204S1206S.
55 Truthmann, J, Richter, A, Thiele, S, et al. (2012) Associations of dietary indices with biomarkers of dietary exposure and cardiovascular status among adolescents in Germany. Nutr Metab 9, 92.
56 Kennedy, ET, Ohls, J, Carlson, S, et al. (1995) The Healthy Eating Index: design and applications. J Am Diet Assoc 95, 11031108.
57 Subar, AF, Kipnis, V, Troiano, RP, et al. (2003) Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. Am J Epidemiol 158, 113.
58 Dodd, KW, Guenther, PM, Freedman, LS, et al. (2006) Statistical methods for estimating usual intake of nutrients and foods: a review of the theory. J Am Diet Assoc 106, 16401650.

Keywords

Type Description Title
WORD
Supplementary materials

Vadiveloo Supplementary Material
Supplementary Material

 Word (94 KB)
94 KB

Development and evaluation of the US Healthy Food Diversity index

  • Maya Vadiveloo (a1), L. Beth Dixon (a2), Tod Mijanovich (a3), Brian Elbel (a4) (a5) and Niyati Parekh (a4) (a6)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed