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The Development and Evaluation of a Diet Quality Index for Asian Toddlers and Its Perinatal Correlates: The GUSTO Cohort Study

1
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
2
HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin 4, Ireland
3
Food Science and Technology Programme, Department of Chemistry, National University of Singapore, Singapore 117543, Singapore
4
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
5
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore
6
Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
7
Duke-NUS Graduate Medical School, Lee Kong Chian School of Medicine, Singapore 169857, Singapore
8
Department of Paediatrics Endocrinology, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
9
Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
10
Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital and National University Health System, Singapore 119074, Singapore
11
Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore 117599, Singapore
12
Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
*
Author to whom correspondence should be addressed.
Co-first authors.
Nutrients 2019, 11(3), 535; https://doi.org/10.3390/nu11030535
Received: 29 January 2019 / Revised: 24 February 2019 / Accepted: 26 February 2019 / Published: 1 March 2019
(This article belongs to the Special Issue Dietary Intake and Eating Behavior in Children)
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Abstract

Early childhood diet may have lifelong influences on health outcomes, yet development of indices to assess diet quality is scarce in toddlers, especially in Asian countries. We aimed to develop and evaluate a Diet Quality Index (DQI) in a multi-ethnic Asian mother–offspring cohort and identify perinatal correlates of early childhood diet. Based primarily on the Singapore dietary guidelines, the DQI includes seven food components: rice, bread and alternatives; fruit; vegetables; meat and alternatives; milk and dairy products; whole grains; and foods high in sugar. The DQI was developed using parental report of Food Frequency Questionnaires (FFQ) data for 18-month-old toddlers (n = 561). The mean ± SD of DQI for the study toddlers was 44.2 ± 8.9 (theoretical range: 0–65). A higher DQI (better diet quality) was associated with higher intakes of several nutrients and food groups (e.g., vegetables, dietary fibre, and beta-carotene; all p < 0.001). Further construct validity was demonstrated by substantial agreement between the FFQ-DQI and 24-hour-recall-DQI (Intraclass-correlation-coefficient: 0.70). Independent predictors of lower DQI included higher maternal pre-pregnancy BMI [β(95% CI): −0.23(−0.39, −0.07)], Malay ethnicity [−1.88(−3.67, −0.09)], lower household income [−1.97(−3.91, −0.03)], lower education level [−2.57(−4.85, −0.28)] and never breastfeeding [−6.17(−11.06, −1.28)]. We developed a valid DQI for assessing the overall quality of the diets of Asian toddlers. View Full-Text
Keywords: diet quality index; toddlers; Asian; dietary guidelines; healthy diet diet quality index; toddlers; Asian; dietary guidelines; healthy diet
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Chen, L.-W.; Fung, S.M.; Fok, D.; Leong, L.P.; Toh, J.Y.; Lim, H.X.; Pang, W.W.; Tan, K.H.; Chong, Y.-S.; Yap, F.; Godfrey, K.M.; Lee, Y.S.; Chong, M. .-F. The Development and Evaluation of a Diet Quality Index for Asian Toddlers and Its Perinatal Correlates: The GUSTO Cohort Study. Nutrients 2019, 11, 535.

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