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Nutrition and Health (including climate and ecological aspects)

Assessment of the Dutch Healthy Diet index 2015 in the Lifelines cohort study at baseline

Abstract

Background

Dietary indices are useful measures to investigate associations between dietary intake and disease development. The Dutch Healthy Diet index 2015 (DHD2015-index), a measure of diet quality, assesses adherence to the 2015 Dutch dietary guidelines. We assessed the DHD2015-index in the Lifelines cohort study, and compared calculations from basic and detailed dietary intake data.

Methods

Dietary intake was assessed with a specially developed Food Frequency Questionnaire (FFQ) called Flower-FFQ, which consists of one main questionnaire (heart-FFQ), which asks for intakes of major food groups, and three complementary questionnaires (petal-FFQs), which ask for detailed information on food types within major food groups of the heart-FFQ. The DHD2015-index was assessed using data from the total Flower-FFQ (for 56,982 participants), and using data from the heart-FFQ only (for 129,030 participants). Agreement between the two indices was assessed with correlation and cross-classification.

Results

The median (25th−75th percentile) DHD2015-index score was 70 (60–80) for men and 76 (65–86) for women based on the Flower-FFQ, and 68 (58–78) for men and 73 (63–83) for women based on the heart-FFQ. The Kendall’s tau-b correlation coefficient between the two scores was 0.66. Cross-classification into quartiles of the DHD2015-index showed that 59–60% of participants were classified in the same quartile, 37% in the adjacent, and 4% in the non-adjacent.

Conclusion

Dietary data from the Flower-FFQ provide the most optimal information to assess the DHD2015-index. However, the DHD2015-index from the heart-FFQ showed good agreement with the index from the Flower-FFQ of ranking participants according to diet quality, and can be used when the DHD2015 index from the Flower-FFQ is not available.

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Fig. 1

Data availability

Data may be obtained from a third party and are not publicly available. Researchers can apply to use the Lifelines data used in this study. More information about how to request Lifelines data and the conditions of use can be found on their website (https://www.lifelines.nl/researcher/how-to-apply).

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Acknowledgements

The authors wish to acknowledge the services of the Lifelines Cohort Study, the contributing research centers delivering data to Lifelines and all study participants.

Funding

The Lifelines initiative has been made possible by subsidy from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen (UMCG), Groningen University and the Provinces in the North of the Netherlands (Drenthe, Friesland, Groningen)

Author information

Authors and Affiliations

Authors

Contributions

AMB conceived the study. EMBB and JHMV developed the Flower FFQ for the Lifelines cohort study. AMB analyzed the data, all authors interpreted the results. AMB wrote the manuscript, all authors critically reviewed it. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to A. Mireille Baart.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The Lifelines study is conducted according to the principles of the Declaration of Helsinki and according to the research code of the University Medical Center Groningen (UMCG). The Lifelines study is approved by the medical ethical committee of the UMCG, The Netherlands. All participants gave written informed consent.

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Supplementary information

41430_2022_1163_MOESM1_ESM.docx

Supplementary table 1. Participant characteristics across quartiles of the DHD2015-index based on the heart-FFQ (n=129,030)

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Baart, A.M., Brouwer-Brolsma, E.M., de Jong, H.B.T. et al. Assessment of the Dutch Healthy Diet index 2015 in the Lifelines cohort study at baseline. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01163-w

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