Public Health Nutrition

Research Paper

Diet quality – what is it and does it matter?

Annika Wirta1 and Clare E Collinsa1 c1

a1 School of Health Sciences, HA12 Hunter Building, University Drive, University of Newcastle, Callaghan, New South Wales 2308, Australia


Objective Measures of diet quality have evolved with a number of scoring indices currently in use. They are increasingly being used to examine epidemiological associations between dietary intake and nutrition-related health outcomes. The present review aims to describe current diet quality tools and their applications, and to examine the relationship between diet quality and morbidity and mortality.

Design A search was conducted of MEDLINE, Cochrane, EMBASE, CINAHL and ProQuest electronic databases. Inclusion criteria were: English language; published from 2004 on; conducted in adult populations; longitudinal/cohort/case–control or cross-sectional study; included a theoretically defined measure of diet quality.

Results A total of twenty-five indices of overall diet quality and/or variety were found, with components ranging from nutrients only to adherence to recommended food group servings, to variety within healthful food groups. The majority of studies reviewed had methodological weaknesses but demonstrated that higher dietary quality was consistently inversely related to all-cause mortality, with a protective effect of moderate magnitude. The associations were stronger for men and for all-cause and CVD mortality.

Conclusions The limitations of both the indices and the studies that use them need to be considered when interpreting and comparing results. However, diet quality indices do appear to be able to quantify risk of some health outcomes, including biomarkers of disease and risk of CVD, some cancers and mortality. Further research is needed to improve the validity of these tools and to adapt them for use in clinical dietetic practice.

(Received May 18 2008)

(Accepted February 05 2009)

(Online publication April 01 2009)


c1 Corresponding author: Email