Holistic Framework to Contextualize Dietary Quality Assessment: A Critical Review
Open accessAbstract
Numerous dietary quality indices exist to help quantify overall dietary intake and behaviors associated with positive health outcomes. Most indices focus solely on biomedical factors and nutrient or food intake, and exclude the influence of important social and environmental factors associated with dietary intake. Using the Diet Quality Index- International as one sample index to illustrate our proposed holistic conceptual framework, this critical review seeks to elucidate potential adaptations to dietary quality assessment by considering—in parallel—biomedical, environmental, and social factors. Considering these factors would add context to dietary quality assessment, influencing post-assessment recommendations for use across various populations and circumstances. Additionally, individual and population-level evidence-based practices could be informed by contextual social and environmental factors that influence dietary quality to provide more relevant, reasonable, and beneficial nutritional recommendations.
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An individual's food choices are influenced by well-established factors such as mood, cognitive process, religion, culture, climate, and socioeconomic conditions.
“An individual’s food choices are influenced by well-established factors such as mood [155], cognitive process, religion, culture, climate, and socioeconomic conditions [156].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [156]
Section 4.1 links religion and culture to food choices; section 4.2 explicitly links economics to food choice; and section 4.3 identifies climate as an influence on dietary quality. The cited paper does not establish cognitive processes as an influence on food choice. Mood is attached to a different citation, [155], rather than this source, [156]. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDietary indices, such as the DASH score, are developed for high-income countries where food sources are plentiful and may not be applicable to lower-income countries.
“Furthermore, dietary indices, such as the DASH score, are developed for high-income countries where food sources are plentiful and may not be applicable to lower-income countries [156,174].”
From Medical Nutrition Therapy for Women with Gestational Diabetes: Current Practice and Future Perspectives (2025) · cites this paper as [156]
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- Authors
- Phelan, J. M., Rosenkranz, R. R., Phelan, C. J., & Rosenkranz, S. K.
- Affiliations
- Kansas State University (US)
- University of Nevada, Las Vegas (US)
- Fort Hays State University (US)
- Corresponding author
- Phelan, Jessica M.
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2023-02-23
- Volume
- 20
- Issue
- 5
- Pages
- 3986
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC10002241
- OpenAlex
- W4321597285
- Cited by
- 4
- References
- 44
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1
- FWCI
- 0.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Scholarship - UNLV (University of Nevada Reno) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- University of Nevada, Las Vegas
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
- Keywords
- dietary quality assessment, Diet Quality Index-International, social determinants of diet, dietary recommendations, food environment
- MeSH terms
- Diet, Eating, Surveys and Questionnaires
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