Validation of the Diet Quality Questionnaire in Chinese Children and Adolescents and Relationship with Pediatric Overweight and Obesity

Abstract

The low-burden Diet Quality Questionnaire (DQQ) has been developed to rapidly assess diet quality globally. Poor diet is often correlated with body size, and certain dietary risk factors can result in overweight and obesity. We aimed to examine the extent to which the DQQ captured food group consumption among children and adolescents in China, and to understand the association of several new indicators of diet quality scores derived from the DQQ with overweight and obesity, using the 2011 wave of the China Health and Nutrition Survey. The DQQ questions are constructed using sentinel foods-that is, food items that are intended to capture a large proportion of the population consuming the food groups. The overall Global Dietary Recommendations (GDR) score, GDR-Healthy score, and GDR-Limit score are novel indicators of diet quality that reflect dietary risk factors for non-communicable diseases derived from the DQQ questions. Multivariable logistic regression analysis was used to examine the associations of the GDR scores with overweight and obesity in the sample. The DQQ questions captured over 95% of children who consumed the food groups. Additionally, we found that the GDR-Limit score was positively associated with general obesity (odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.17-1.74) and abdominal obesity (OR = 1.22, 95% CI: 1.05-1.43), whereas the overall GDR score was negatively related to general obesity (OR = 0.85, 95% CI: 0.74-0.97). The low-burden DQQ could be a valid tool to assess diet quality for the Chinese pediatric population aged 7-18 years. Poor diet quality, as determined by the GDR-Limit score, is associated with the increased risk of obesity in Chinese children and adolescents.

Keywords: Diet Quality Questionnaire; children and adolescents; global dietary recommendations; obesity; overweight.

Figure 1

Flow chart of the inclusion/exclusion of participants.

Figure 2

Percentage (%) of the consumption of sentinel food items compared with all food items in respective 29 food groups by sex, age, and residence. Note: 1: Staple foods made from grains; 2: Whole grains; 3: White root/tubers; 4: Legumes; 5: Vitamin A-rich orange vegetables; 6: Dark green leafy vegetables; 7: Other vegetables; 8: Vitamin A-rich fruits; 9: Citrus; 10: Other fruits; 11: Grain-baked sweets; 12: Other sweets; 13: Eggs; 14: Cheese; 15: Yogurt; 16: Processed meats; 17: Unprocessed red meat (ruminant); 18: Unprocessed red meat (nonruminant); 19: Poultry; 20: Fish and seafood; 21: Nuts and seeds; 22: Packaged ultra-processed salty snacks; 23: Instant noodles; 24: Deep fried foods; 25: Fluid milk; 26: Sweetened tea/coffee/milk drinks; 27: Fruit juice; 28: Sugar-sweetened beverages (sodas); 29: Fast food.

Figure 3

Prevalence of overweight and obesity by Global Dietary Recommendations (GDR) scores.

Figure 4

Prevalence of abdominal obesity by Global Dietary Recommendations (GDR) scores.

Figure 5

Associations of the Global Dietary Recommendations scores with overweight and obesity by sex, age, and residence. Note: CI, confidence interval; GDR, global dietary recommendations; OR, odds ratio. Logistic regression analyses were used to calculate the odds ratios and 95% confidence intervals with adjustment for sex, age, residence, and urbanicity index.