Review Article

A critical review of predefined diet quality scores

Patricia M. C. M. Waijersa1 c1, Edith J. M. Feskensa1 and Marga C. Ockéa1

a1 Centre for Nutrition and Health, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands


The literature on predefined indexes of overall diet quality is reviewed. Their association with nutrient adequacy and health outcome is considered, but our primary interest is in the make-up of the scores. In total, twenty different indexes have been reviewed, four of which have gained most attention, and many others were based on those four. The various scores differ in many respects, such as the items included, the cut-off values used, and the exact method of scoring, indicating that many arbitrary choices have been made. Correlations in intake between dietary components may not be adequately addressed. In general, diet quality scores show an association with mortality or disease risk, but these relations are generally modest. Existing indexes do not predict morbidity or mortality significantly better than individual dietary factors. Although conclusions from the review may provide guidance in the construction of a diet quality score, it is questionable whether a dietary score can be obtained that is a much better predictor of health outcome.

(Received March 09 2006)

(Revised July 07 2006)

(Accepted August 29 2006)


c1 *Marga Ocké, fax +31 30 2744466;


Abbreviations: NNR, Nordic Nutrition Recommendations