The Development and Evaluation of a Diet Quality Index for Asian Toddlers and Its Perinatal Correlates: The GUSTO Cohort Study
Ling-Wei Chen,
Si Ming Fung,
Doris Fok,
Lai Peng Leong,
Jia Ying Toh,
Hui Xian Lim,
Wei Wei Pang,
Kok Hian Tan,
Yap-Seng Chong,
Fabian Yap,
Keith M Godfrey,
Yung Seng Lee,
Mary Foong-Fong Chong
Affiliations
Ling-Wei Chen
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Si Ming Fung
Food Science and Technology Programme, Department of Chemistry, National University of Singapore, Singapore 117543, Singapore
Doris Fok
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Lai Peng Leong
Food Science and Technology Programme, Department of Chemistry, National University of Singapore, Singapore 117543, Singapore
Jia Ying Toh
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore
Hui Xian Lim
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore
Wei Wei Pang
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Kok Hian Tan
Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
Yap-Seng Chong
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Fabian Yap
Duke-NUS Graduate Medical School, Lee Kong Chian School of Medicine, Singapore 169857, Singapore
Keith M Godfrey
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
Yung Seng Lee
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
Mary Foong-Fong Chong
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore
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.