Development of the Eating Choices Index (ECI)

Transcription

1 Development of the Eating Choices Index (ECI) GK Pot 1, CJ Prynne 1, M Richards 2, AM Stephen 1 1 MRC Human Nutrition Research, Cambridge UK 2 MRC Unit for Lifelong Health and Ageing, London UK

2 Background Capture diet in one measure Numerous diet quality tools: Healthy Eating Index (HEI) Mediterranean Diet Score (MDS), etc. Mostly targeted at meeting recommendations in terms of nutrients or consumption of specific types of food Existing diet indices not aimed at dietary behaviour

3 Objective To develop an score that discriminates between overall healthy and unhealthy dietary behaviour can be applied to dietary assessments of various types (including diet diaries and repeated 24HR) can also be used as a short questionnaire to categorise individuals in large surveys

4 Elements of Eating Choices Index (ECI) 1. Frequency of Breakfast consumption Important indicator of healthy diet Often not assessed in FFQs 2. Type of milk Consumption of low-fat milk associated with overall dietary intake lower in fat and higher in fibre 3. Type of bread Associated with improved dietary quality 4. Fruit intake Important component of healthy diet Easier to quantify than vegetable intake

5 MRC National Survey of Health and Development 1946 British Birth Cohort n=1253 n=5632 n= Birth N=16,695 M BF = Dietary Assessment

6 Components of Eating Choices Index (ECI) Factor Factor name Category 1 Category 2 Category 3 Category 4 Category 5 1 Frequency of Breakfast No days Some days All days but not all days Score Type of milk Whole (min Some whole, 1.Semi- Some semi- Skimmed consumed 3.5%) only some semiskimmed (1.7%) skimmed only skimmed, some skimmed only (0.1%) Score Type of bread White only Some white, 1.Brown or Some brown or Wholemeal consumed some brown or granary granary only 2. Some granary, some wholemeal only white, some wholemeal Score Fruit intake portions (per day) 0 >0 <1 1 >1 2 3 Score Higher score, healthier dietary behaviour

7 Methods Correlations and quartiles of ECI score with indicator nutrients including macronutrients, and fibre, vitamin C, iron, calcium and folate Tracking over time (n=1253) Exploration of subgroup analyses of Low and high social class (manual vs. non-manual) BMI (based on WHO cut-offs) Four fruits vs. total fruits

8 Components of ECI Breakfast factor Milk factor Bread factor Women Men Fruit factor ECI ECI score

9 Fat (% FE) Carbohydrate (% FE) ECI correlates well with macronutrients Carbohydrate (% food energy) q1 q2 q3 q4 q1 q2 q3 q4 q1 q2 q3 q4 r CHO All 0.25 Men 0.26 Women 0.22 Similar for protein r Protein All 0.18 Men 0.13 Women 0.21 ALL men women Fat (%food energy) q1 q2 q3 q4 q1 q2 q3 q4 q1 q2 q3 q4 r Fat All Men Women ALL men women

10 ECI correlates well with fibre and micronutrients Fibre: Total NSP (g/d) q1 q2 q3 q4 q1 q2 q3 q4 q1 q2 q3 q4 ALL men women All Men Women NSP Vitamin C Iron Calcium Folate

11 ECI & Tracking over time 100% 90% 80% 70% 60% 50% 40% 30% 82 ECI >=15 82 ECI ECI ECI <=9 20% 10% 0% All n=1253

12 ECI and socio-economic status 100% n=432 n=565 n=492 n=615 P trend < % 80% 70% 60% 50% 40% Manual Non manual 30% 20% 10% 0% 89 ECI <=9 89 ECI ECI ECI >=15 Missing data n=152 In 1989, 43y

13 ECI and BMI 100% n=432 n=565 n=492 n=615 P trend < % 80% 70% 60% obese (>=30.0) 50% overweight ( ) normal weight ( ) 40% underweight (<18.5) 30% 20% 10% 0% ECI <=9 ECI ECI ECI >=15 Missing data n=13 In 1989, 43y

14 Four fruits vs. total fruit 64% of total fruit intake from four fruits: apples, pears, bananas, and oranges Correlations with indicator nutrients very similar Nutrient r ECI four fruits r ECI total fruit Fat (% FE) -0.22* -0.22* Protein (% FE) 0.15* 0.18* CHO (% FE) 0.29* 0.25* NSP # 0.51* 0.51* Vitamin C # 0.32* 0.37* Iron 0.29* 0.29* Calcium 0.25* 0.24* Folate 0.23* 0.21* # data transformed, * p< 0.001

15 Discussion Generalizability Comparison to other Diet quality scores Tracking over time: Changes in food availability Dietary recommendations Ageing of population Total fruit consumption vs. four fruits

16 Conclusion We have developed a score that Discriminates between overall healthy and unhealthy behaviour Can be applied to dietary assessments of various types Can also be used as a short questionnaire to categorise individuals in large surveys Next Validate as short questionnaire Relate to health outcomes longitudinally Examine in other population groups

17 Acknowledgements NSHD cohort members NSHD Interviewers & Researchers MRC Unit for Lifelong Health and Ageing

18 Thank you for your attention MRC Human Nutrition Research Cambridge, UK