Hostname: page-component-5d59c44645-jqctd Total loading time: 0 Render date: 2024-02-27T09:52:21.967Z Has data issue: false hasContentIssue false

Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort)

Published online by Cambridge University Press:  02 January 2007

M Maynard*
Affiliation:
MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK
AR Ness
Affiliation:
Department of Paediatric and Perinatal Epidemiology, University of Bristol, Bristol, UK
L Abraham
Affiliation:
Outcomes Research, Sandwich, UK
D Blane
Affiliation:
Department of Social Science and Medicine, Imperial College of Science, Technology and Medicine, London, UK
C Bates
Affiliation:
MRC Human Nutrition Research, Cambridge, UK
DJ Gunnell
Affiliation:
Department of Social Medicine, University of Bristol, Bristol, UK
*
*Corresponding author: Email maria@msoc.mrc.gla.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives

To describe the selection and modification of an appropriate diet score to assess diet quality in early old age.

Design and setting

Cross-sectional analyses of the Boyd Orr cohort – a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy.

Subjects

In total, 1475 traced, surviving cohort members aged 60 years and over.

Results

Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r = 0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r = −0.57), red meat (r = −0.46), dietary fibre (r = 0.58), fruit and vegetables (r = 0.54) and percentage energy from carbohydrates (r = 0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items.

Conclusions

The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.

Type
Research Article
Copyright
Copyright © The Authors 2005

References

1Block, G. Epidemiologic evidence regarding vitamin C and cancer. American Journal of Clinical Nutrition 1991; 54: 1310S–4S.CrossRefGoogle ScholarPubMed
2Ascherio, A, Rimm, EB, Giovannucci, E, Speigelman, D, Stampfer, MJ, Willett, WC. Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. British Medical Journal 1996; 313: 8490.CrossRefGoogle ScholarPubMed
3Hu, FB, Stampfer, MJ, Manson, JE, Rimm, E. Colditz, GA, Rosner, BA, et al. Dietary fat intake and the risk of coronary heart disease in women. New England Journal of Medicine 1997; 337: 1491–9.CrossRefGoogle ScholarPubMed
4Hu, FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Current Opinion in Lipidology 2002; 13: 39.CrossRefGoogle ScholarPubMed
5Kant, AK. Indexes of overall diet quality: a review. Journal of the American Dietetic Association 1996; 96: 785–91.CrossRefGoogle ScholarPubMed
6Dubois, L, Girard, M, Bergeron, N. The choice of a diet quality indicator to evaluate the nutritional health of populations. Public Health Nutrition 2000; 3: 357–65.CrossRefGoogle ScholarPubMed
7Margetts, BM, Campbell, NA, Armstrong, BK. Summarizing dietary patterns using multivariate analysis. Journal of Human Nutrition 1981; 35: 281–6.Google ScholarPubMed
8Togo, P, Heitman, BL, Sorensen, TIA, Osler, M. Consistency of food intake factors by different dietary assessment methods and population groups. British Journal of Nutrition 2003; 90: 667–78.CrossRefGoogle ScholarPubMed
9Hu, FB, Rimm, EB, Stampfer, MJ, Ascherio, A, Spiegelman, D, Willett, WC. Prospective study of major dietary patterns and risk of coronary heart disease in men. American Journal of Clinical Nutrition 2000; 72: 912–21.CrossRefGoogle ScholarPubMed
10Fung, TT, Rimm, EB, Spiegelman, D. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular risk. American Journal of Clinical Nutrition 2001; 73: 61–7.CrossRefGoogle Scholar
11Bell, RA, Quant, SA, Vitolins, MZ, Arcury, TADietary patterns of older adults in a rural, tri-ethnic community: a factor analysis approach Nutrition Research 2003; 23: 1379–90.CrossRefGoogle Scholar
12Quatromoni, PA, Copenhafer, DL, Demissie, S, D'Agostino, RB, O'Horo, CE, Nam, BH, et al. The internal validity of a dietary pattern analysis: the Framingham nutrition studies Journal of Epidemiology and Community Health 2002; 56: 381–8.CrossRefGoogle ScholarPubMed
13Greenwood, DC, Cade, JE, Draper, A, Barrett, JH, Calvert, C, Greenhalgh, A. Seven unique food consumption patterns identified among women in the UK Women's Cohort Study. European Journal of Clinical Nutrition 2000; 54: 314–20.CrossRefGoogle ScholarPubMed
14Huijbregts, P, Feskens, E, Rasanen, L, Fidanza, F, Nissinen, A, Menotti, A, et al. Dietary patterns and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. British Medical Journal 1997; 315: 13–7.CrossRefGoogle ScholarPubMed
15Jacques, PF, Tucker, KL. Are dietary patterns useful for understanding the role of diet in chronic disease? American Journal of Clinical Nutrition 2001; 73: 12.CrossRefGoogle ScholarPubMed
16Dynesen, AW, Haraldsdottir, J, Holm, L, Astrup, A. Sociodemographic differences in dietary habits described by food frequency questions. European Journal of Clinical Nutrition 2003; 57: 1586–97.CrossRefGoogle ScholarPubMed
17Kim, S, Haines, PS, Siega-Riz, A-M, Popkin, BM. The Diet Quality Index–International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. Journal of Nutrition 2003; 133 3476–84.CrossRefGoogle ScholarPubMed
18Fitzgerald, AL, Maclean, DR, Veugelers, PJ. ietary reference intakes: a comparison with the Nova Scotia Nutrition Survey. Canadian Journal of Dietetic Practice and Research 2002; 63: 176–83.CrossRefGoogle Scholar
19Haines, PS, Siega-Riz, A-M, Popkin, BM. The Diet Quality Index Revised: a measurement instrument for populations. Journal of the American Dietetic Association 1999; 99: 697704.CrossRefGoogle ScholarPubMed
20Neuhouser, ML, Patterson, RE, King, IB, Horner, NK, Lampe, JW. Selected nutritional biomarkers predict diet quality. Public Health Nutrition 2003; 6: 703–9.CrossRefGoogle ScholarPubMed
21Newby, PK, Hu, FB, Rimm, EB, Smith-Warner, SA, Feskanich, D, Sampson, L, et al. Reproducibility and validity of the Diet Quality Index Revised as assessed by use of a food frequency questionnaire. American Journal of Clinical Nutrition 2003; 78: 941–9.CrossRefGoogle ScholarPubMed
22Seymour, JD, Calle, EE, Flagg, EW, Coates, RJ, Ford, ES, Thun, MJ. Diet quality ndex as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II nutrition cohort. American Journal of Epidemiology 2003; 157: 980–8.CrossRefGoogle Scholar
23Fitzgerald, AL, Maclean, DR, Veugelers, PJ. Diet quality and cancer incidence in Nova Scotia, Canada. Nutrition and Cancer 2002; 43: 127–32.CrossRefGoogle ScholarPubMed
24Kant, AK, Schatzkin, A, Graubard, BI, Schairer, C. A prospective study of diet quality and mortality in women. Journal of the American Medical Association 2000 283: 2109–15.CrossRefGoogle ScholarPubMed
25McCullough, ML, Feskanich, D, Rimm, EB, Giovannucci, EL, Ascherio, A, Variyam, JN, et al. Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. American Journal of Clinical Nutrition 2000; 72: 1223–31.CrossRefGoogle Scholar
26Trichopoulou, A, Kouris-Blazos, A, Wahlqvist, ML, Gnardellis, C, Lagiou, P, Polychronopoulos, E, et al. Diet and overall survival in elderly people. British Medical Journal 1995 311 1457–60.CrossRefGoogle ScholarPubMed
27Juni, P, Witschi, A, Bloch, R, Egger, M. The hazards of scoring the quality of clinical trials for meta-analysis. Journal of the American Medical Association 1999; 282: 1054–60.CrossRefGoogle ScholarPubMed
28Gunnell, DJ, Frankel, S, Nanchahal, K, Braddon, FEM, Davey Smith, G. Lifecourse exposure and later disease: a follow-up study based on a survey of family diet and health in pre-war Britain. Public Health 1996; 110: 8594.CrossRefGoogle ScholarPubMed
29Bingham, SA, Gill, C, Welch, A, Cassidy, A, Runswick, SA, Oakes, S, et al. Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. International Journal of Epidemiology 1997; 26: S137–51.CrossRefGoogle ScholarPubMed
30Ministry of Agriculture, Fisheries and Food. Food Portion Sizes. London: HMSO, 1993.Google Scholar
31Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food. McCance & Widdowson's The Composition of Foods. London: HMSO, 1991.Google Scholar
32Department of Health. Nutritional Aspects of the Development of Cancer. Report on Health and Social Subjects No. 48 London: HMSO, 1998.Google Scholar
33Department of Health. Nutritional Aspects of Cardiovascular Disease. Report on Health and Social Subjects No. 46 London: HMSO, 1994.Google Scholar
34World Health Organization (WHO). Diet, Nutrition and Prevention of Chronic Diseases. Report of a WHO Study Group. Technical Report Series No. 797 Geneva: WHO, 1990.Google Scholar
35Haveman-Nies, A, Tucker, KL, de Groot, LCP, Wilson, PWF, van Staveren, WA. 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. European Journal of Clinical Nutrition 2001; 55 870–80.CrossRefGoogle ScholarPubMed