Key result
Higher positive Global Diet Quality Score is linked to ~31% lower all-cause mortality.
Why the study?
Few studies have assessed the relationship between the Global Diet Quality Score and cardiovascular and all-cause mortality, particularly in African populations.
Does higher diet quality as assessed by the Global Diet Quality Score reduce all-cause and CVD mortality in Black South African adults?
Cohort
Does higher diet quality as assessed by the Global Diet Quality Score reduce all-cause and CVD mortality in Black South African adults?
Higher intake of healthy foods as measured by the GDQS+ submetric is associated with lower all-cause mortality in Black South African adults, but the GDQS- submetric may be misleading in settings of food insecurity.
Answers are grounded in this paper and cite their sources.
GDQS+ was associated with lower all-cause mortality; extends GDQS validation to African cohorts but leaves GDQS- utility open in food-insecure settings.
BACKGROUND: Modifiable risk factors for cardiovascular diseases (CVDs) include diet quality. The Global Diet Quality Score (GDQS) was designed to provide a comprehensive diet quality assessment, yet very few studies have assessed its relationship with CVD and all-cause mortality, particularly in an African setting. OBJECTIVES: We aimed to determine the association between the baseline total GDQS, GDQS positive (GDQS+), and GDQS negative (GDQS-) and all-cause and CVD mortality after 13 y of follow-up in Black South African adults (aged 30-70 y). GDQS+ reflects healthy food intake, whereas GDQS- is reverse-scored (higher scores indicating lower intake of unhealthy foods). Across all GDQS measures, higher scores indicate better diet quality. METHODS: The baseline dietary data from the Prospective Urban Rural Epidemiology-North West Province-South Africa study were used to calculate the GDQS, with mortality outcomes recorded 13 y later. Cox proportional hazards models were applied, stratified by sex, age group, and observation time tertiles. Models were adjusted for lifestyle factors and health status. Hazard ratios (HRs) were calculated for baseline GDQS tertiles. RESULTS: The overall GDQS was low in both survivors and nonsurvivors, reflecting low intake of many GDQS healthy food groups, with only whole grains and liquid oils reaching desirable levels (to give maximum points to the GDQS+). Compared with tertile (T1), participants in T3 of the GDQS+ had a lower risk of all-cause mortality [HR: 0.69; 95% confidence interval (CI): 0.56, 0.86], whereas those in T3 of the GDQS- had a higher risk (HR: 1.39; 95% CI: 1.12, 1.73). No associations were found with CVD mortality. CONCLUSIONS: The GDQS is a valuable tool for investigating all-cause mortality risk in African populations through its GDQS+ submetric. However, caution is warranted when applying the GDQS in settings of dietary monotony or food insecurity, particularly the GDQS- submetric which gives maximum points for low intake/avoidance of unhealthy food groups.
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Shivambu et al. (2026) reported a cohort. Global Diet Quality Score positive (GDQS+) highest tertile (T3) vs. Lowest tertile (T1) was evaluated on All-cause mortality (HR 0.69, 95% CI 0.56, 0.86). Higher scores on the positive submetric of the Global Diet Quality Score were associated with a lower risk of all-cause mortality (HR 0.69; 95% CI 0.56-0.86) in Black South African adults.
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