Association between Diet-Quality Scores, Adiposity, Total Cholesterol and Markers of Nutritional Status in European Adults: Findings from the Food4Me Study

Abstract

Diet-quality scores (DQS), which are developed across the globe, are used to define adherence to specific eating patterns and have been associated with risk of coronary heart disease and type-II diabetes. We explored the association between five diet-quality scores (Healthy Eating Index, HEI; Alternate Healthy Eating Index, AHEI; MedDietScore, MDS; PREDIMED Mediterranean Diet Score, P-MDS; Dutch Healthy Diet-Index, DHDI) and markers of metabolic health (anthropometry, objective physical activity levels (PAL), and dried blood spot total cholesterol (TC), total carotenoids, and omega-3 index) in the Food4Me cohort, using regression analysis. Dietary intake was assessed using a validated Food Frequency Questionnaire. Participants (n = 1480) were adults recruited from seven European Union (EU) countries. Overall, women had higher HEI and AHEI than men (p < 0.05), and scores varied significantly between countries. For all DQS, higher scores were associated with lower body mass index, lower waist-to-height ratio and waist circumference, and higher total carotenoids and omega-3-index (p trends < 0.05). Higher HEI, AHEI, DHDI, and P-MDS scores were associated with increased daily PAL, moderate and vigorous activity, and reduced sedentary behaviour (p trend < 0.05). We observed no association between DQS and TC. To conclude, higher DQS, which reflect better dietary patterns, were associated with markers of better nutritional status and metabolic health.

Keywords: Dutch Healthy Diet Index; Healthy Eating Index; Mediterranean Diet Score; diet scores; dried blood spots; metabolic health; nutritional biomarkers; personalized nutrition.

Figure 1

(a) Healthy Eating Index (HEI); (b) Alternate Healthy Eating Index (AHEI); (c) MedDietScore (MDS); (d) PREDIMED MDS (P-MDS); and, (e) Dutch Healthy Diet Index (DHDI) according to country recruiting participants to the Food4Me Study. Values represent means ± standard error of mean (SEM). UK, United Kingdom; IE, Ireland; PL, Poland; NL, The Netherlands; GE, Germany; SP, Spain; GR, Greece. Significant differences observed across all diet quality scores (p < 0.001) following general linear models adjusted for age and sex (HEI and AHEI): for (a) UK vs. PL p < 0.001; IE vs. PL p = 0.002; NL vs. PL p < 0.001; IE; SP vs. PL p < 0.001; GR vs. PL p < 0.001, (b) UK vs. PL p < 0.001; UK vs. SP p < 0.001; UK vs. GR p < 0.001; NL vs. PL p = 0.006; NL vs. SP p = 0.030; NL vs. GR p = 0.005; GE vs. PL p = 0.020; GE vs. GR p = 0.014, (c) SP vs. UK p < 0.001, SP vs. IE p < 0.001; SP vs. PL p < 0.001; SP vs. NL p < 0.001; SP vs. GE p < 0.001; GR vs. UK p < 0.001; GR vs. IE p < 0.001; GR vs. PL p < 0.001; GR vs. GE p < 0.001; NL vs. UK p < 0.001; IE vs. PL p = 0.003; GE vs. PL p < 0.001, (d) SP vs. UK p = 0.024; SP vs. IE p < 0.001; SP vs. PL p < 0.001; SP vs. NL p < 0.001, SP vs. GE p < 0.001; SP vs. GR p < 0.001; UK vs. PL p < 0.001; UK vs. IE p = 0.024; GR vs. PL p < 0.001; GR vs. IE p < 0.001; GR vs. GE p < 0.001; IE vs. PL p = 0.001; NL vs. PL p = 0.038, (e) UK vs. PL p < 0.001; UK vs. GE p = 0.002; UK vs. GR p < 0.001; NL vs. IE p = 0.022; NL vs. PL p < 0.001; NL vs. GE p < 0.001; NL vs. GR p < 0.001; SP vs. IE p < 0.001; SP vs. PL p < 0.001; SP vs. GE p < 0.001; SP vs. GR, p < 0.001.