The diet quality index evaluates the adequacy of energy provided by dietary macronutrients

MENDES, Aline; GAVIOLI, Larissa; PREVIDELLI, Ágatha Nogueira; FISBERG, Regina Mara; MARCHIONI, Dirce Maria Lobo

doi:10.1590/1415-52732015000400001

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Sumário

Original Articles • Rev. Nutr. 28 (4) • Aug 2015 • https://doi.org/10.1590/1415-52732015000400001 copy

The diet quality index evaluates the adequacy of energy provided by dietary macronutrients

Índice de qualidade da dieta e adequação de energia fornecida por macronutrientes

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To investigate the relationship between macronutrient intake adequacy and the national diet quality index score.

Methods

The study analyzed a representative sample of 1,662 individuals from the municipality of São Paulo who participated in a cross-sectional study called Health Survey-Capital (2008/2009). Two 24-hour recalls were collected. Habitual intake was determined by the Multiple Source Method. The Brazilian index was calculated as suggested, and macronutrient adequacy was given by the World Health Organization and Food and Agriculture Organization recommendations. A generalized linear model verified the relationship between the Brazilian index and macronutrient adequacy. All analyses with a descriptive level below 0.05 were considered significant. The analyses were performed by the software Stata 12.0, survey mode.

Results

The vast majority (91%) of the population had inappropriate macronutrient intakes, and the total median Brazilian index score was 61.3 points (interquartile range=10.1). The total Brazilian index score of individuals with high lipid intake was worse than that of individuals with proper lipid intake (β=0,96; p=0,004), while those with high protein intake had a better score (β=1,10; p=0,003) than those with proper protein intake.

Conclusion

The revised Brazilian Healthy Eating Index assesses diet quality properly regarding high lipid intake, but it has some limitations regarding high protein intake according to the World Health Organization and Food and Agriculture Organization recommendations. New studies should investigate the possibility of adapting this index to the World Health Organization and Food and Agriculture Organization recommendations.

Diet; Diet surveys; Macronutrients; Recommended dietary allowances

Macronutrients	Intake adequacy
	Below		Within		Above
	Mean*	SE*	Mean	SE	Mean	SE
Carbohydrates Proteins Lipids	99.5 00.1 00.1	0.20 0.08 0.05	0.20 0.08 0.05	0.2^a 0.5^b 0.9^c	- 97.8 93.1	- 0.5 0.9

IQDR and components	Macronutrients
	Total amount	Carbohydrates			Proteins			Lipids
	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)	Median (IQR)
Total BHEI	61.3 (10.1)	61.3 (10.1)	65.0 (5.5)	-	36.9 (27.6)	54.8 (12.4) ^#	61.4 (10.1)^#	63.4 (23.8)	65.9 (10.3)^†	61.1 (9.9)^†
Total fruits	2.7 (3.3)	2.7 (3.3)^#	5.0 (2.6)^#	-	1.6 (3.4)	1.9 (1.2)	2.7 (3.3)	5.0 (2.9)	4.1 (3.2) ^#	3.3 (3.3)^#
Whole fruits	3.3 (3.3)	3.3 (3.3)	5.0 (2.0)	-	1.9 (3.2)	2.0 (3.3)	3.3 (3.3)	5.0 (3.2)	3.6 (3.4)	3.3 (0.1)
Total vegetables	5.0 (0.0)	5.0 (0.0)	5.0 (0.0)	-	5.0 (0.0)	5.0 (0.0)	5.0 (0.0)	5.0 (1.1)	5.0 (0.0)	5.0 (0.0)
Dark green/orange vegetables and legumes¹ Total grains	5.0 (0.0) 5.0 (0.0)	5.0 (0.0) 5.0 (0.0)	5.0 (0.0) 5.0 (0.9)	-	5.0 (0.0) 4.2 (0.6)^†	5.0 (0.0) 5.0 (0.9)^†	5.0 (0.0) 5.0 (0.0)	5.0 (0.0) 2.6 (2.7)	5.0 (0.0) 5.0 (0.2)	5.0 (0.0) 5.0 (0.0)
Whole grains	0.2 (0.3)	0.2 (0.3)	0.2 (1.2)	-	0.2 (2.5)	0.3 (0.2)	0.2 (0.3)	0.1 (0.3)	0.2 (0.3)	0.2 (0.3)
Milk and dairy products Meats, eggs, and legumes Saturated fats	05.1 (3.7) 9.2 (1.5) 7.8 (3.0)	5.1 (3.7)^# 9.2 (1.5) 7.7 (3.0)^†	2.7 (3.6)^# 5.5 (6.3) 10.0 (0.4)^†	-	4.9 (3.5) 3.2 (0.9)^† 0 (8.8)	5.0 (6.4) 6.1 (3.6)^† 8.2 (4.9)	5.1 (3.7) 9.2 (1.4)^† 7.7 (3.0)	1.9 (5.1) 4.8 (7.0) 10.0 (0.0)^†	4.8 (5.0) 9.2 (2.0) 9.5 (1.3)^†	5.1 (3.7) 9.2 (1.4) 7.5 (3.1)†
SoFAA²	7.9 (6.9)	7.9 (6.8)	14.1 (9.2)	-	0 (5.8)	5.2 (9.8)	7.9 (6.8)	0 (18.6)	9.6 (9.8)	7.8 (6.7)
Oils	10.0 (0.0)	10 (0.0)	10 (0.0)	-	5.5 (4.5)	10 (0.0)	10 (0.0)	10 (0.0)^#	10 (0.0)^#	10 (0.0)
Sodium	1.6 (2.7)	1.6 (2.7)	2.4 (3.5)	-	5.5 (4.5)^†	3.9 (3.3)^†	1.5 (2.6)^†	9.6 (7.0)^†	1.5 (3.6)^†	1.6 (0.8)

Independent variable	Categories	Coefficients and significance
Independent variable		β^†	p^†§	β^‡	p^‡§
Carbohydrate adequacy (%)	Below the RR Within the RR Above the RR	0.95 - -	0.195 - -	1.01 - -	0.787 - -
Protein adequacy (%)	Below the RR Within the RR Above the RR	0.84 - 1.10	0.337 - 0.005	0.84 - 1.10	0.392 - 0.005
Lipid adequacy (%)	Below the RR Within the RR Above the RR	0.98 - 0.94	0.839 - <0.001	1.04 - 0.96	0.686 - 0.001
Education level of the household head (years)		0.99	0.016	0.99	0.592
Sex	Male Female	- 1.03	- 0.002	- 1.02	- 0.038
Age group	Adolescents Adults Older adults	- 1.05 1.13	- <0.001 <0.001	- 1.04 1.11	- <0.001 <0.001
Physical activity	Inadequate Active	- 0.99	- 0.301	- 1.002	- 0.873
Habitual calorie intake (kcal)		0.99	<0.001	0.99	0.022

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[1] Correspondência para/Correspondence to: DML Marchioni. E-mail: <marchioni@usp.br>