Development and Validation of the Global Diet Quality Score (GDQS) for Children 5 to 9 Years of Age

OBJECTIVE: The purpose of the study was to develop and validate a Global Diet Quality Score (GDQS) for children aged 5-9 years adapted from the existing GDQS developed for adults. BACKGROUND: Diet quality is important for nutrient adequacy and risk of nutrition-related chronic disease. A diet quality metric for global use with children is needed. METHODS: The 25 food groups of the GDQS were used to assign points for categories of consumption according to gram-weight cutoffs adapted for children based on energy requirements. As a preliminary step, alternative versions of gram-weight cutoffs were tested by comparing correlation analyses using 4 existing dietary datasets from low-, middle-, and high-income countries. A final GDQS metric version, selected based on strength of correlations and operational feasibility, was further examined in regression analyses with individual nutrient intake an overall nutrient intake adequacy score and biomarker and anthropometry outcomes in 7 dietary datasets from different countries. Regressions were also undertaken with other diet quality metrics to compare their relative performance with that of the GDQS. RESULTS: The GDQS had strong associations with most nutrient intakes, including an overall mean nutrient adequacy score and some nutrients associated with noncommunicable disease risk, such as fiber and added sugar. Biomarker data were limited in the available datasets and few associations with GDQS were found. The GDQS performed better or as well as other dietary quality metrics in predicting nutrient intakes. CONCLUSION: The GDQS was associated with nutrient intakes and fills a gap in a global diet quality metric for children. The GDQS will be a useful tool to measure diet quality and monitoring changes in diet quality over time.