2021 Articles

The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries

Bromage, Sabri; Zhang, Yiwen; Holmes, Michelle D; Sachs, Sonia E; Fanzo, Jessica C.; Remans, Roseline; Sachs, Jeffrey D; Batis, Carolina; Bhupathiraju, Shilpa N; Fung, Teresa T; Li, Yanping; Stampfer, Meir J; Deitchler, Megan; Willett, Walter C; Fawzi, Wafaie W

Background: Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunica­ ble diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality = 8 3 :J to this double burden. Objectives: We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDOS) against Dani:' other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. � � Methods: We scored the GDOS, Minimum Dietary Diversity-Women (MDD-W). and Alternative Healthy Eating lndexen C: 2010 (AHEl-2010) using FFO data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) "'Cl "'Cl ro in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and 3 age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. (:1J) I� Results: Correlations between the GDOS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, ...... iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% Cl: 0.30, 0.38) in men and 0.37 (95% Cl: 0.32, (0 (/) 0.41) in women. The GDOS was associated (P < 0.05) with lower odds of low MUAC [GDOS quintile (0) 5 compared a; .j>. 0 with 01 OR in men: 0.44, 95% Cl: 0.22, 0.85; women: 0.57, 95% Cl: 0.31, 1.03] and anemia (05/01 OR in men: 0.56, (0 01 95% Cl: 0.32, 0.98; women: 0.60, 95% Cl: 0.35, 1.01 ). The MDD-W correlated better with some nutrient intakes, though w.j>. CT associated marginally with low MUAC in men (P= 0.07). The AHEl-2010 correlated better with fatty acid intakes, though '< tC C: associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was (1) !e. low, and neither the GDOS, MDD-W, nor AHEl-2010 were predictive. Conclusions: The GDOS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in