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International food group–based diet quality and risk of coronary heart disease in men and women
Open accessAbstract
Background Standard diet quality assessment tools, which measure micronutrient sufficiency and food consumption related to disease and applicable to different populations, are needed to track progress in meeting the Sustainable Development Goals related to hunger, food security, and nutrition. Diet quality scores have been constructed for high- and low-income countries, but none are simple to administer or applicable internationally.Objective We prospectively examined the association between the Food Group Index (FGI), the Minimal Diet Diversity Score for Women (MDDW), and a new Prime Diet Quality Score (PDQS), and the risk of ischemic heart disease (IHD) in 3 US cohorts.Design In total, 75,045 women (baseline age 43-63 y), 43,966 men (aged 40-75 y), and 93,131 younger women (aged 27-44 y) without a history of cardiovascular disease were followed up to 28 y. Diet was assessed multiple times using food frequency questionnaires and the 3 diet quality scores were computed for each individual. The association with IHD was modeled with Cox proportional hazard models, controlling for potential confounders.Results During follow-up, we ascertained 2908 incident IHD cases in the Nurses' Health Study, 3722 in the Health Professionals Follow-up Study, and 505 in the Nurses' Health Study II. The FGI was not associated with total IHD in any cohort. The PDQS was significantly associated with IHD in all 3 cohorts separately and the pooled RR for each SD increase was 0.89 (95% CI: 0.87, 0.91). This was significantly different than the pooled RR of 0.93 for MDDW (95% CI: 0.90, 0.96) and the RR of 0.98 for the FGI (95% CI: 0.95, 1.01). The association did not appear to differ by age.Conclusion We found that the PDQS with the most detailed differentiation of healthy and unhealthy foods was associated with a lower risk of IHD in a high-income country. On the other hand, diet quality scores that do not account for unhealthy foods had a limited association with IHD.
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“The PDQS is a validated dietary quality index (DQI) based on food consumption patterns [16].”
From The association between the Mediterranean Diet and the Prime Diet Quality Score and polycystic ovary syndrome: a case control study (2025) · cites this paper as [16]
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“It has been reported that adherence to a high PDQS diet, rich in fiber and healthy fats, promotes better insulin sensitivity.”
From The association between the Mediterranean Diet and the Prime Diet Quality Score and polycystic ovary syndrome: a case control study (2025) · cites this paper as [16]
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“The GDQS also tended to outperform the PDQS-like Metric in this respect (Table 11) and in predicting MetS in China (9).”
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Fadda, A., Sanna, D., Sakar, E. H., Gharby, S., Mulas, M., Medda, S., Şahin‐Yeşilçubuk, N., Karaça, A. C., Kırkın, C., Lucarini, M., et al. (2022) · Sustainability · doi:10.3390/su14020849 · Cited by 195
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“It is based on the Prime Screen questionnaire and tries to meet both simplicity in assessing dietary habits and high discriminative ability to identify associations with the risk of non-communicable diseases, adopting a world-wide perspective 21 .”
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“While a traditional dietary pattern can include both healthy and unhealthy foods [147], it is not clear whether the proportions of these products are compatible with a traditional diet in Mexico.”
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“WHO-FV ≥400 g/d of fruits and vegetables (1) Dark-green leafy vegetables; (2) Vitamin A–rich orange-colored vegetables, roots, and tubers; (3) Other vegetables; (4) Vitamin A-rich fruits; (5) Citrus fruits; (6) Other fruits (including red/purple/blue fruits) 0–6 ≥3”
BackgroundInfluentialKronsteiner-Gicevic, S., Gaskins, A. J., Fung, T. T., ROSNER, B. A., Tobias, D. K., Isanaka, S., & Willett, W. C. (2018) · PLoS ONE · doi:10.1371/journal.pone.0195103 · Cited by 84
“[17] found only a weak inverse association between MDD-W and risk of coronary heart disease (CHD) and no association between FGI and CHD, while PDQS had a strong, inverse association with the outcome.”
InfluentialSelf-citationMadzorera, I., Isanaka, S., Wang, M., Msamanga, G., Urassa, W. K., Hertzmark, E., Duggan, C., & Fawzi, W. W. (2020) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa172 · Cited by 86
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“It has been used to explore linkages between diet and coronary artery disease (21), pregnancy-related outcomes (22, 23), and child growth (24), but also to develop new metrics for food biodiversity in diets (25).”
BackgroundAljuraiban, G. S., Gibson, R., Griep, L. M. O., Okuda, N., Steffen, L. M., Horn, L. V., & Chan, Q. M. (2019) · Advances in Nutrition · doi:10.1093/advances/nmz059 · Cited by 77
“Fung et al, 2018 (18) USA FGI, MDDS for women, PDQS FGI not associated with total IHD in any cohort (26-y”
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Self-citationUyar, B. T. M., Talsma, E. F., Herforth, A., Trijsburg, L. E., Vogliano, C., Pastori, G., Bekele, T. H., Hương, L. T., & Brouwer, I. D. (2022) · Journal of Nutrition · doi:10.1016/j.tjnut.2022.12.014 · Cited by 64
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“Citrus was added instead, following its use in another indicator validated for NCD protection, Prime Diet Quality Score (PDQS, later developed into the GDQS) [14,40].”
BackgroundMethodHanley‐Cook, G., Huybrechts, I., Biessy, C., Remans, R., Kennedy, G., Deschasaux, M., Murray, K. A., Touvier, M., Skeie, G., Kesse‐Guyot, E., et al. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003834 · Cited by 48
“Furthermore, several prospective studies have reported lower mortality and chronic disease rates among participants with higher between food group diversity [27,28], within specific food group richness (e.”
Ojeda‐Rodríguez, A., Zazpe, I., Alonso-Pedrero, L., Zalba, G., Guillén‐Grima, F., Martínez‐González, M. Á., & Martí, A. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.11.003 · Cited by 46
Higher Global Diet Quality Score Is Inversely Associated with Risk of Type 2 Diabetes in US Women
Fung, T. T., Li, Y., Bhupathiraju, S. N., Bromage, S., Batis, C., Holmes, M. D., Stampfer, M. J., Hu, F. B., Deitchler, M., & Willett, W. C. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab195 · Cited by 47
“The GDQS was modified based on the PDQS (9) to capture food groups that would reflect nutrient adequacy and predict major noncommunicable diseases in both lower- and high-income countries globally.”
BackgroundMethodInfluentialSelf-citationMadzorera, I., Ismail, A., Hemler, E. C., Korte, M. L., Adedokun, O., Wang, D., Assefa, N., Workneh, F., Lankoandé, B., Chukwu, A. U., et al. (2021) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.20-1617 · Cited by 45
“Not eating for awholedayduring thepastmonth (multivariate-adjusted estimate, 20.85; 95% CI, 21.32 to 20.38)was associatedwith a lower PDQS.”
MethodInfluentialChanges in the Global Diet Quality Score, Weight, and Waist Circumference in Mexican Women
Angulo, E., Stern, D., Castellanos-Gutiérrez, A., Monge, A., Lajous, M., Bromage, S., Fung, T. T., Li, Y., Bhupathiraju, S. N., Deitchler, M., et al. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab171 · Cited by 42
“AHEI-2010, Alternate Healthy Eating Index-2010; GDQS, Global Diet Quality Score; MDD-W, Minimum Dietary Diversity for Women.”
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Self-citationHigher Global Diet Quality Score Is Associated with Less 4-Year Weight Gain in US Women
Fung, T. T., Li, Y., Bromage, S., Bhupathiraju, S. N., Batis, C., Fawzi, W. W., Holmes, M. D., Stampfer, M. J., Hu, F. B., Deitchler, M., et al. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab170 · Cited by 39
“We have developed the Global Diet Quality Score (GDQS) based on the Prime Diet Quality Score (16).”
MethodInfluentialSelf-citationChen, Q., Li, L., Yi, J., Huang, K., Shen, R., Wu, R., & Yao, C. (2020) · Molecular Genetics & Genomic Medicine · doi:10.1002/mgg3.1186 · Cited by 39
Kronsteiner-Gicevic, S., Tahirović, E., Bromage, S., & Willett, W. C. (2021) · Public Health Nutrition · doi:10.1017/s1368980021000859 · Cited by 34
“CHD, gestational diabetes and hypertension in pregnancy(13,14).”
MethodSelf-citationMozaffari, H., Hosseini, Z., Lafrenière, J., & Conklin, A. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2021.1925630 · Cited by 34
“…cancer (Reedy et al. 2008), CVDs (Larsson, Åkesson, and Wolk 2014a; Larsson, Åkesson, and Wolk 2014b), and even mortality (Kobayashi et al. 2020; Lee et al. 2011; McNaughton, Bates, and Mishra 2012), but others report null associations (Fung et al. 2018; Letois et al. 2016; Smyth et al. 2016).”
BackgroundInfluentialYang, J., Wang, M., Tobias, D. K., Rich-Edwards, J. W., Darling, A. M., Abioye, A. I., Noor, R. A., Madzorera, I., & Fawzi, W. W. (2021) · Maternal and Child Nutrition · doi:10.1111/mcn.13300 · Cited by 34
“PDQS, on the other hand, can differentiate healthy and unhealthy foods by negatively scoring consumption of foods that are associated with obesity, inflammation, and insulin resistance (Fung et al., 2018; Madzorera et al., 2020).”
BackgroundMethodInfluentialMadzorera, I., Blakstad, M. M., Bellows, A. L., Canavan, C. R., Mosha, D., Bromage, S., Noor, R. A., Webb, P., Ghosh, S. A., Kinabo, J., et al. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa329 · Cited by 36
“The PDQS considers consumption of unhealthy saturated fats, consumption of refined grains, and excess consumption of red and processed meats that have been associated with an increased risk of chronic diseases, including coronary heart disease and hypertension, in highincome settings (13, 47, 71).”
BackgroundKronsteiner-Gicevic, S., Tello, M., Lincoln, L. E., Kondo, J. K., Naidoo, U., Fung, T. T., Willett, W. C., & Thorndike, A. N. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.05.023 · Cited by 32
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“Although several global metrics of diet quality for WRA exist, such as the Minimum Dietary Diversity for Women (MDD-W) and the Prime Diet Quality Score, currently none can capture the double burden of malnutrition (7, 8).”
BackgroundSelf-citationAbdallah, F., John, S. E., Hancy, A., Paulo, H. A., Sanga, A., Noor, R., Lankoande, F., Chimanya, K., Masumo, R. M., & Leyna, G. H. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000280 · Cited by 31
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The Effect of Walnut Flour on the Physical and Sensory Characteristics of Wheat Bread
Almoraie, N. M. (2019) · International Journal of Food Science · doi:10.1155/2019/5676205 · Cited by 31
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“Moreover, FGDS was not associated with type II diabetes [18] or ischemic heart disease rates in multiple United States cohorts [71], whereas higher GDQS (cid:2) (but not GDQS þ ) was associated with lower rates of diabetes in the United States [18].”
Wolfson, J. A., Posluszny, H., Kronsteiner-Gicevic, S., Willett, W. C., & Leung, C. W. (2022) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2022.05.009 · Cited by 28
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“Diverse diets, based on a wide variety of nutrient-dense foods between and within food groups, are associated with a greater likelihood of covering micronutrient requirements [5 – 7] and lower rates of noncommunicable diseases [8,9].”
BackgroundDesign and Field Methods of the ARISE Network COVID-19 Rapid Monitoring Survey
Hemler, E. C., Korte, M. L., Lankoandé, B., Millogo, O., Assefa, N., Chukwu, A. U., Workneh, F., Tinkasimile, A. K., Lyatuu, I., Soura, A., et al. (2021) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.20-1618 · Cited by 26
“consumption of food groups to allow for the computation of dietary diversity scores and a food-based dietary score (the Prime Diet Quality Score) differentiating healthy foods from unhealthy foods based on associations with chronic diseases.(43) To assess food security, questions were adapted from the Household Food I…”
MethodMadzorera, I., Bromage, S., Mwanyika‐Sando, M., Vandormael, A. M., Sherfi, H. A., Worku, A., Shinde, S., Noor, R. A., Bärnighausen, T., Sharma, D., et al. (2023) · Maternal and Child Nutrition · doi:10.1111/mcn.13463 · Cited by 31
“…the consumption of healthy foods, as well as unhealthy food groups that have been associated with diet ‐ related chronic diseases (Alvarez ‐ Alvarez et al., 2020; Bromage, Batis, et al., 2021; Fung et al., 2018, 2020) and poor pregnancy outcomes (Gicevic et al., 2018; Madzorera et al., 2020).”
Madlala, S. S., Hill, J., Kunneke, E., Kengne, A. P., Peer, N., & Faber, M. (2022) · Nutrients · doi:10.3390/nu14153191 · Cited by 29
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“Number of adolescents, N 297 300 294 296 365 243 1,795 Age, years 16 (14, 18) 15 (13, 17) 15 (12, 18) 17 (15, 18) 15 (13, 17) 17 (14, 19) 16 (13, 18) Girls, N (%) 140 (47.”
Lee, M. M., Poole, M. K., Zack, R. M., Fiechtner, L. G., Rimm, E. B., & Kenney, E. L. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1007177 · Cited by 23
“First, we computed an “Overall Diet Quality” measure by assigning a point to each food frequency response, consistent with prior work (28).”
MethodChalermsri, C., Ziaei, S., Ekström, E., Muangpaisan, W., Aekplakorn, W., Satheannoppakao, W., & Rahman, S. M. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1002066 · Cited by 21
“There was no association between DDS and ischemic heart disease when using the scores, which simply counted the number of food groups people consumed (39).”
BackgroundA scoping review of approaches used to develop plant-based diet quality indices
Marchese, L. E., McNaughton, S. A., Hendrie, G. A., Wingrove, K., Dickinson, K. M., & Livingstone, K. M. (2023) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2023.100061 · Cited by 21
Oliveira, M. L., Biggers, A., Oddo, V. M., Yanez, B. R., Booms, E., Sharp, L. K., Naylor, K. B., Wolf, P. G., & Tussing-Humphreys, L. M. (2024) · Journal of Nutrition · doi:10.1016/j.tjnut.2024.03.002 · Cited by 19
“The empirical dietary and lifestyle index for hyperinsulinemia is an overall diet quality score ranging from 0 to 42 that is comprised of 21 food groups; a higher score re fl ects more hyperinsulinemic dietary and lifestyle patterns [21,22].”
BackgroundMadzorera, I., Jaacks, L. M., Paarlberg, R., Herforth, A., Bromage, S., Ghosh, S. A., Myers, S. S., Masters, W. A., & Fawzi, W. W. (2021) · Current Developments in Nutrition · doi:10.1093/cdn/nzab062 · Cited by 24
“Global Diet Quality Score (GDQS) and its predecessor, the Prime Diet Quality Score (PDQS) (20, 21), and a suite of indicators on Global Di-”
BackgroundInfluentialDemographic and socio-economic predictors of diet quality among adults in Bosnia and Herzegovina
Kronsteiner-Gicevic, S., Gaskins, A. J., Fung, T. T., ROSNER, B. A., Sabanovic, E., Milešević, J. P., Kadvan, A. L., Kremic, E., & Willett, W. C. (2019) · Public Health Nutrition · doi:10.1017/s1368980019001988 · Cited by 19
“Prime Diet Quality Score The Prime Diet Quality Score (PDQS)(23,24) is a food-based,”
BackgroundMethodSelf-citationRestaurant dining during the COVID-19 pandemic among adults with low-income in the United States
Cohen, J. F. W., Posluszny, H., Falbe, J., Mueller, M. P., Gearhardt, A. N., Leung, C. W., & Wolfson, J. A. (2022) · Appetite · doi:10.1016/j.appet.2022.105976 · Cited by 18
Slotnick, M. J., & Leung, C. W. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.08.019 · Cited by 18
Ataei Kachouei, A., Kamrani, F., Haghighatdoost, F., Mohammadifard, N., Najafi, F., Farshidi, H., Lotfizadeh, M., Kazemi, T., Karimi, S., Roohafza, H., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-20369-0 · Cited by 18
“It categorizes poultry and fish as healthy foods while considering red meat unhealthy [9].”
BackgroundMethodDietary Research on Coffee: Improving Adjustment for Confounding
R.Thomas, D., & Hodges, I. D. (2019) · Current Developments in Nutrition · doi:10.1093/cdn/nzz142 · Cited by 20
“Food groups, such as fruit, vegetables, red meat, and nuts, were used to assess the effectiveness of adjustment for dietary patterns because they are commonly used to construct diet quality assessment tools (23, 24).”
MethodKenney, E., Adebiyi, V. O., Seligman, H. K., Ehmke, M. D., Guthrie, J. F., Coleman‐Jensen, A., & Frongillo, E. A. (2024) · Current Nutrition Reports · doi:10.1007/s13668-024-00547-7 · Cited by 17
Dietary Diversity and the Risk of Fracture in Adults: A Prospective Study
Zhang, J., Liang, D., & Zhao, A. (2020) · Nutrients · doi:10.3390/nu12123655 · Cited by 17
“Although the DDS-MDD-W was developed for women aged 15 to 49 years, this score was also used in men [27].”
MethodZazpe, I., Santiago, S., Toledo, E., Bes‐Rastrollo, M., de la Fuente‐Arrillaga, C., & Martínez‐González, M. Á. (2021) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2021.03.011 · Cited by 17
Ajorlouie, Z., Moshkian, P., Baghdadi, G., Amiri, R., Biglari, F., & Rahimlou, M. (2025) · BMC Nutrition · doi:10.1186/s40795-025-01067-5 · Cited by 17
“The PDQS is a validated dietary quality index (DQI) based on food consumption patterns [16].”
InfluentialInfant Food Security in New Zealand: A Multidimensional Index Developed from Cohort Data
Schlichting, D., Hashemi, L., & Grant, C. C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16020283 · Cited by 15
“In order to combine simplicity in assessing diet quality with the ability to differentiate healthy foods from unhealthy ones [33], punitive scoring is applied to unhealthy foods and use of coping methods.”
BackgroundCano-Ibáñez, N., Serra-Majem, L., Martín-Peláez, S., Martínez-González, M. Á., Salas-Salvadó, J., Corella Piquer, M. D., Lassale, C., Martínez Hernandez, J. A., Alonso-Gómez, Á. M., Wärnberg, J., et al. (2022) · British Journal of Nutrition · doi:10.1017/s0007114521004323 · Cited by 15
“This PDQS is based on the Prime Screen Questionnaire, a short diet assessment tool developed for clinical use to quickly assess diet quality (22) and widely used by other authors (15) .”
A simple fruit and vegetable score is a valid tool to assess actual fruit and vegetable intake
Pastori, G., Brouwer, I. D., Feskens, E. J. M., Hương, L. T. T., Samuel, F. O., Xuan, L. T. T., Shittu, O. F., Eyinla, T. E., & Talsma, E. F. (2023) · British Journal Of Nutrition · doi:10.1017/s0007114523001125 · Cited by 13
“However, the FGDS does not provide information on the risk of diet-related non-communicable diseases and has not been validated for men (11) .”
BackgroundThe COVID-19 pandemic and its impacts on diet quality and food prices in sub-Saharan Africa
Ismail, A., Madzorera, I., Apraku, E. A., Tinkasimile, A. K., Dasmane, D., Zabré, P., Millogo, O., Assefa, N., Chukwu, A. U., Workneh, F., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0279610 · Cited by 14
“We classif d from the 20 food groups foods into 14 healthy food groups (dark green leafy vegetables, other vitamin A-rich vegetables including carrots, cruciferous vegetables, other vegetables, whole citrus fruits, other fruits, fish, poultry, legumes, nuts, low-fat dairy, whole grains, eggs and liquid vegetable oils)…”
MethodDietary quality and risk of heart failure in men
Gu, X., Wang, D. D., Fung, T. T., Mozaffarian, D., Djoussé, L., ROSNER, B. A., Sacks, F. M., & Willett, W. C. (2022) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqac119 · Cited by 15
Self-citationWomen's input and decision-making in agriculture are associated with diet quality in rural Tanzania
Madzorera, I., Bliznashka, L., Blakstad, M. M., Bellows, A. L., Canavan, C. R., Mosha, D., Bromage, S., Noor, R. A., Webb, P., Ghosh, S. A., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1215462 · Cited by 12
Slotnick, M. J., Falbe, J., Wolfson, J. A., Jones, A. D., & Leung, C. W. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.11.021 · Cited by 11
Burden and determinants of anaemia among in‐school young adolescents in Ethiopia, Sudan and Tanzania
Partap, U., Tadesse, A. W., Shinde, S., Sherfi, H. A., Mank, I., Mwanyika‐Sando, M., Sharma, D., Bärnighausen, T., Drysdale, R. E., Worku, A., et al. (2023) · Maternal and Child Nutrition · doi:10.1111/mcn.13439 · Cited by 11
“Points for each food group were then summed to give an overall score (Fung et al., 2018; Rifas ‐ Shiman et al., 2001), and quartiles were created for analytical purposes.”
Said, F. A., Khamis, A. G., Salmin, A., Msellem, S. N., Mdachi, K., Noor, R. A., Leyna, G. H., & Mchau, G. (2023) · PLoS ONE · doi:10.1371/journal.pone.0293316 · Cited by 10
Wong, M. M. H., & Louie, J. C. Y. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2021.1897517 · Cited by 10
Hosseini‐Esfahani, F., Daei, S., Ildarabadi, A., Koochakpoor, G., Mirmiran, P., & Azizi, F. (2024) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes24001 · Cited by 9
“12,13 However, no prior study has investigated the effectiveness of GDQS in predicting MetS or its components.”
Wolfson, J. A., Altema-Johnson, D., Yett, A., Ali, E., Kim, B. F., Carr, N., Santo, R. E., Cho, C., Browning, G., & Ramsing, R. (2025) · Appetite · doi:10.1016/j.appet.2025.108001 · Cited by 8
“More information about the development and validation of the PDQS diet quality index and its associated data collection tool (PDQS-30D) is available elsewhere (Fung et al., 2018; Gicevic et al., 2018, 2021).”
Liu, Z., Zhao, D., Dai, S., Liang, Y. J., Zhao, M., Liu, M., Zhong, Z., Liang, L., Tian, Z., & Yang, Y. (2024) · Journal of Nutrition · doi:10.1016/j.tjnut.2024.02.008 · Cited by 8
Nsabimana, P., Gutema, B. T., Langley, K., Vasanthakaalam, H., de Henauw, S., Somé, J., & Abbeddou, S. (2024) · Nutrition and Metabolism · doi:10.1186/s12986-024-00859-z · Cited by 7
“Solid-fat and spreads, alcohols, and tea and coffee were not scored following the validated method of Bromage et al. [37].”
InfluentialMohammadifard, N., Rahimlou, M., Amani‐Beni, R., Darouei, B., Zarepur, E., Haghighatdoost, F., Nazemzadeh-Harandi, S., Azdaki, N., Salehi, N., Lotfizadeh, M., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-95719-y · Cited by 9
“…with prior research findings that have recognized the PDQS as a marker of dietary quality, showing inverse associations with various health outcomes such as PCAD 64 , pregnancy 39 and birth complications 65 , uterine fibroids 66 , and overall mortality across diverse geographic populations 67,68 .”
Kim, H. S., Lee, H., Provido, S. M. P., Kang, M., Chung, G. H., Hong, S., Yu, S. H., Lee, C. B., & Lee, J. E. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.647661 · Cited by 9
“study examining the risk of coronary heart disease using the data from three cohort studies did not observe a significant association with MDD-W (28).”
MethodBaghdadi, G., Feyzpour, M., Shahrokhi, S. A., Amiri, R., & Rahimlou, M. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1529374 · Cited by 8
Diet to Stop Hypertension: Should Fats be Included?
Nestel, P. J., & Mori, T. A. (2024) · Current Hypertension Reports · doi:10.1007/s11906-024-01310-7 · Cited by 7
“The Prime Diet Quality Score [39] includes 21 food groups, 14 of which are classified as healthy and 7 as unhealthy.”
BackgroundMistry, N. F., Hemler, E. C., Dholakia, Y. N., Bromage, S., Shukla, A., Dev, P., Govekar, L., Tipre, P., Shah, D., Keshavjee, S. A., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-039935 · Cited by 8
Agyemang, P., Kwofie, E. M., Aidoo, R., Allotey, D. K., & Ngadi, M. O. (2023) · Food Policy · doi:10.1016/j.foodpol.2023.102475 · Cited by 7
“The dietary intake and nutrient adequacy information was estimated using two indicators based on ten food groups: the individual dietary diversity score (IDDS) (Habte and Krawinkel, 2016) and minimum dietary diversity -Women (MDDW) (Fung et al., 2018).”
MethodSun, J., Guo, X., Geng, X., & Ren, X. (2019) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2019.06.023 · Cited by 6
Healthy food diversity and the risk of major chronic diseases in the EPIC-Potsdam study
Nickel, D., Jannasch, F., Eroglu, E. I., Kuxhaus, O., & Schulze, M. B. (2024) · Scientific Reports · doi:10.1038/s41598-024-78287-5 · Cited by 5
Martin, K. M., Radler, D. R., Sackey, J. D., Zhang, C., Shrestha, K., Shrestha, A., Shrestha, A., Barrett, E. S., & Rawal, S. (2022) · BMC Nutrition · doi:10.1186/s40795-022-00623-7 · Cited by 5
“fruits, vegetables, whole grains) increases the total score and indicates a higher diet quality (0–1 servings/week = 0 points, 2–3 servings/week = 1 point, 4 + servings/week = 2 points) [29, 30].”
BackgroundMethodDietary intake and associated risk factors among pregnant women in Mbeya, Tanzania
Killel, E., Mchau, G., Mbilikila, H., Azizi, K. A., Julius, N., Hancy, A., Lukindo, T., Mwiru, R. S., Noor, R., Sanga, A., et al. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002529 · Cited by 5
Mehrabani, S., Moori, M. H., Noormohammadi, M., Shoja, M., Eskandarzadeh, S., Kazemi, S. N., Rashidkhani, B., Nouri, M., & Eslamian, G. (2025) · Journal of Health Population and Nutrition · doi:10.1186/s41043-025-00800-x · Cited by 5
“The PDQS, developed by Fung et al. [18], is a simple, food-based diet quality score that differentiate healthy foods from unhealthy ones based on two main criteria: (1) evidence from the literature regarding the relationship between food and the risk of non-communicable diseases, and (2) the global…”
de Castro-Mendes, F., Cunha, P., Paciência, I., Rufo, J. C., Farraia, M., Silva, D., Padrão, P., Delgado, L., Moreira, A. M., & Moreira, P. A. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052646 · Cited by 4
“It was also shown that a higher MDD-W was modestly associated with a lower risk of ischemic heart disease [28].”
BackgroundBrennan, S., Finlay, R., Ferrari, M., Grohmann, T., Courtney, A., Cardwell, C. R., Brennan, L., & Woodside, J. V. (2022) · Proceedings of The Nutrition Society · doi:10.1017/s0029665122001264 · Cited by 5
Evaluation of the Prime Diet Quality Score from Early Childhood Through Mid-Adolescence
Switkowski, K. M., Kronsteiner-Gicevic, S., Rifas‐Shiman, S. L., Lightdale, J. R., & Oken, E. (2024) · Journal of Nutrition · doi:10.1016/j.tjnut.2024.04.014 · Cited by 4
Brennan, S. F., Finlay, R., Ferrari, M., Cardwell, C. R., Brennan, L., & Woodside, J. V. (2024) · Journal of Nutritional Science · doi:10.1017/jns.2024.23 · Cited by 4
Haghighatdoost, F., Feizi, A., Hajihashemi, P., Shahoon, H., Ani, A., Roohafza, H., & Adibi, P. (2024) · Nutritional Neuroscience · doi:10.1080/1028415x.2024.2372190 · Cited by 3
“To date, the inverse association of PDQS with several chronic disease, such as cardiovascular disease, type 2 diabetes, obesity, hypertension and metabolic syndrome, has been suggested [13–15].”
Haji-Adineh, S., & Mozafaripoor, A. (2018) · Journal of Research in Behavioural Sciences · doi:10.52547/rbs.16.4.508 · Cited by 3
Karimi, E., Heidari, H., Kazemi, M., Hadi, A., Askari, G., Khorvash, F., & Arab, A. (2025) · Nutritional Neuroscience · doi:10.1080/1028415x.2025.2454168 · Cited by 2
“Patients taking herbal or nutritional supplements (such as coenzyme Q10, riboflavin, magnesium, or feverfew) or reporting total energy intake outside the range of 800– 4000 kcal/day for men and 500–3500 kcal/day for women, based on the food frequency questionnaire (FFQ) [27], were also excluded.”
Costa, J. C., Darling, A. M., Shinde, S., Tadesse, A. W., Sherfi, H. A., Mwanyika‐Sando, M., Tinkasimile, A. K., Sharma, D., Bärnighausen, T., & Fawzi, W. W. (2024) · Maternal and Child Nutrition · doi:10.1111/mcn.13583 · Cited by 3
“…10 – 14 years from Ouagadougou, Addis Ababa, Khartoum and Dar es Salaam. ensure that it was appropriate for young adolescents (Ballard et al., 2011; Chandra ‐ Mouli et al., 2017; Darling et al., 2020; Fung et al., 2018; Kennedy et al., 2010; Milner et al., 2008; World Health Organization, 2017).”
Associations Between Perceived Tap Water Safety and Dietary Outcomes Among US Adults
Slotnick, M. J., Leung, C. W., Tucker, A. C., Jones, A. D., & Wolfson, J. A. (2025) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2025.07.004 · Cited by 1
Jones, A. D., Hoey, L., Leung, C. W., Slotnick, M. J., Hao, W., Oppliger, K., Bryan, A., Giardini, S., Kim, H. Y., Mangan, S., et al. (2025) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2025.09.008 · Cited by 1
Martin, K. M., Shah, K., Shrestha, A., Barrett, E. S., Shrestha, K., Zhang, C., Shrestha, A., Byham-Gray, L. D., & Rawal, S. (2022) · Maternal and Child Health Journal · doi:10.1007/s10995-022-03547-7 · Cited by 1
Computationally Modelling Cholesterol Metabolism and Atherosclerosis
Davies, C., Morgan, A. E., & Auley, M. T. M. (2023) · Biology · doi:10.3390/biology12081133 · Cited by 1
“Non-exhaustively, this includes; physical inactivity [6], genetic predisposition [7], obesity [8], metabolic syndrome [9], nutrition [10,11], tobacco smoke [12], gut microbiome changes [13], epigenetic changes [14], and elevated homocysteine [15].”
BackgroundImpact of COVID-19 on food security and diet quality in Chilanga District, Zambia
Sridhar, S., Kang, J. S., Makasa, J., Bell-Cross, S., Madzorera, I., Zulu, E., & Hamer, D. H. (2024) · Journal of Health Population and Nutrition · doi:10.1186/s41043-024-00523-5 · Cited by 1
“Foods were further categorized as unhealthy vs healthy based on the Prime Diet Quality Score (PDSQ) [24].”
MethodSmagul, G., Sinyavskiy, Y. A., Tuigunov, D. N., & Савенкова, Т. В. (2024) · Bulletin of Shakarim University Technical Sciences · doi:10.53360/2788-7995-2024-1(13)-36 · Cited by 1
Metadata
- Authors
- Fung, T. T., Isanaka, S., Hu, F. B., & Willett, W. C.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Fung, Teresa T
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 107
- Issue
- 1
- Pages
- 120-129
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC5972643
- OpenAlex
- W2789711714
- Cited by
- 120
- References
- 21
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 19 · 2023: 16 · 2022: 17 · 2021: 24 · 2020: 6 · 2019: 12 · 2018: 5
- FWCI
- 11.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UM1-CA-176726, UM1-CA167552, CA176726, CA-167552)
- National Heart, Lung, and Blood Institute (R01HL035464, R01HL034594)
- National Cancer Institute (UM1CA176726, UM1CA186107)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
- Keywords
- diet quality, coronary artery disease, ischemic heart disease, unhealthy food, diet quality index, women, men, Nurses' Health Study, Health Professionals Follow-up Study, Nurses' Health Study II
- MeSH terms
- Adult, Aged, Edible Grain, Coronary Disease, Diet, Female, Follow-Up Studies, Food Supply, Fruit, Humans, Fabaceae, Life Style, Male, Middle Aged, Nuts, Prospective Studies, Surveys and Questionnaires, Risk Factors, Vegetables, Exercise, Nutrition Assessment, Body Mass Index, Incidence
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