Introducing a Suite of Low-Burden Diet Quality Indicators That Reflect Healthy Diet Patterns at Population Level

BACKGROUND: Few low-burden indicators of diet quality exist to track trends over time at low cost and with low technical expertise requirements. OBJECTIVE: The aim was to develop and validate a suite of low-burden indicators to reflect adherence to global dietary recommendations. METHODS: Using nationally representative, cross-sectional, quantitative dietary intake datasets from Brazil and the United States, we tested the association of food-group scores with quantitative consumption aligned with 11 global dietary recommendations. We updated the Healthy Diet Indicator (HDI) to include current quantifiable recommendations of the WHO (HDI-2020). We developed 3 food-group–based scores—an overall Global Dietary Recommendations (GDR) score as an indicator of all 11 recommendations composed of 2 subcomponents: GDR-Healthy, an indicator of the recommendations on “healthy” foods, and GDR-Limit, an indicator of the recommendations on dietary components to limit. We tested associations between these scores and the HDI-2020 and its respective subcomponents. We developed 9 dichotomous food-group–based indicators to reflect adherence to the global recommendations for fruits and vegetables, dietary fiber, free sugars, saturated fat, total fat, legumes, nuts and seeds, whole grains, and processed meats. We conducted receiver operating characteristic and sensitivity-specificity analyses to determine whether the dichotomous indicators were valid to predict adherence to the recommendations in both countries. RESULTS: The GDR score and its subcomponents were moderately to strongly associated with the HDI-2020 and its respective subcomponents (absolute values of rank correlation coefficients ranged from 0.55 to 0.66). Of the 9 dichotomous indicators, 8 largely met the criteria for predicting individual global dietary recommendations in both countries; 1 indicator (total fat) did not perform satisfactorily. CONCLUSIONS: Food-group consumption data can be used to indicate adherence to quantitative global dietary recommendations at population level. These indicators may be used to track progress of countries and populations toward meeting WHO guidance on healthy diets.