Short Tools to Assess Young Children's Dietary Intake: A Systematic Review Focusing on Application to Dietary Index Research

Table 5

Studies examining diet quality indices among infants and toddlers (birth-24 months) and preschoolers (2–5 years), details of the content of the indices and their applicability to short dietary assessment tools identified in Table 1.

Index name; reference details; age of sample	Index properties			Applicability to short tools identified in Table 1			Can be applied to dietary data assessed by short tools reviewed (Table 1)
	Number of components: component labels	Assesses		Requires
		Five “core” food groups	“Noncore” foods	Assessment of food-group subcategories	Detailed nutrient analysis	Portion size quantification^a
Infants and toddlers (birth-24 months)
Mean Adequacy Ratio (MAR); Hoerr et al. 2006 [32]; 11–25 m	Nutrients included in ratio score vary according to research interests. 8 key nutrients used in [32]	—	—	—	√	√	N
Dietary Diversity Score, international; Dewey et al. 2006 [33]; 1-2 y	8 or 9 food groups: cereals, roots and tubers, vitamin A-rich fruit and vegetables, other fruit and vegetables, legumes and nuts, meat and alternatives, fats and oils, dairy, and eggs, (fruits and vegetables separate for 9-food group DDS)	√	—	√	—	—	N
Healthy Eating Index-Canada (HEI-C); Glanville and McIntyre 2006 [34]; 1–3 y	9: grains, fruit and vegetables, milk, meat, other foods (high in fat, sodium, and sat fat), total fat, saturated fat, cholesterol, and variety	√	√	—	√	√	N
Food Variety Score (FVS), South Africa; Steyn et al. 2006 [35]; 1–3 y	1: dietary diversity. One point for every food item consumed over 24-hour period from 45-item list^b.	—	—	—	—	—	N
Diet Quality Score 2 (DQS2), USA; Caliendo et al. 1977 [36]; 1–4 y	6: vegetables, fruit, breads and cereals, meat and milk, citrus fruit, dark green, and yellow vegetables	√	—	√	—	√	N
Child Feeding Index; Ruel et al. 2002 [37]; 1–3 y	7: breastfeeding, does not use bottle^c, dietary diversity, food frequency, (egg/fish/poultry), food frequency (meat), food, frequency (grains/tubers), and meal frequency	—	—	—	—	—	N
Nutrient Adequacy Score; Krebs-Smith and Clark 1989 [38]; 1–3 y	12: milk and milk products, whole grains, enriched grains, total grains, citrus fruit, other fruit and vegetables, total fruit, green and yellow vegetables, starchy vegetables, other vegetables, total vegetables, and meat and alternatives	√	—	√	—	√	N
Preschoolers (2–5 years)
Crombie et al. 2009 [39]; 2 y	vegetables; dairy products; meat, fish or alternatives; high-fat or high-sugar snacks	√	√	—	—	√	Y [20, 21, 26–28, 30]
Nutrient Quality Index (NQI), Germany; Libuda et al. 2009 [40]; 2–4 y	17: nutrients: vitamins A, E, K, B6, B12, and C, thiamine, riboflavin, niacin, pantothenic acid, folate; minerals calcium, magnesium, iron, phosphorus, potassium, and zinc	—	—	—	√	√	N
Healthy Eating Index (HEI), USA; Manios et al. 2009 [41]; 2–5 y	10: Grains, vegetables, fruits, milk, meat, total fat (% calories), saturated fat (% calories), total, cholesterol, sodium, and variety	√	—	—	√	√	N
Servings/day, USA; Kranz et al. 2009 [42]; 2–5 y	5: fruit, vegetables, grains, milk/dairy, meat/alternatives	√	—	—	—	√	Y [20, 21, 26–28, 30]
HEI-2005, USA; Fungwe et al. 2009 [43]	12: whole fruit (not juice), total vegetables, dark green and orange vegetables and legumes, total and alternatives and beans, food oils, saturated fat, sodium, extra calories from solid fats (including fat in milk), and added sugars	√	√	√	√	√	N
Healthy Nutrition score (HuSKY); Kleiser et al. 2009 [26]; 3–6 y	11: beverages, vegetables, fruit, fish, breads and dairy products, eggs, meat and sausage, fats and oils (butter/margarine), sweets and fatty snacks, and soft drinks	√	√	—	—	√	Y [26]
Revised Children’s Diet; USA; Kranz et al. 2008 [44] Kranz et al. 2006 [45]; 2–5 y	13: added sugar, total fat, fat quality—linoleic, fat docosahexaenoic, total grains, whole grains, vegetables, fruits, 100% fruit juice, dairy, iron intake, and energy balance	—	√	√	√	√	N
Dietary Diversity Score; Sullivan et al. 2006 [31]; <5y	Dietary diversity.; 7: grains-roots-tubers, legumes and nuts, dairy, meat-poultry-fish-eggs, vitamin A-rich fruits and vegetables, other fruits and vegetables, and foods cooked with fat or oil	√	—	√	—	—	Y [31]
Diet Quality Index for Children; Kranz et al. 2004 [46]; 2–5 y Variety Index for toddlers	8: % total energy as added sugars, total fat, saturated fat, number of servings of grains, fruit and vegetables, dairy, excessive juice, and iron (mg/d); 5: bread group, vegetable group, fruit group, and dairy	—	—	—	√	√	N
(VIT); Cox et al. 1997 [47]; 2-3 y	Group, meat group	√	—	—	—	√	Y [20, 21, 26–28, 30]
Diet Quality Score 1 (DQS1), Canada; Campbell and Sanjur 1992 [48]; 2–4 y	6: milk, meat and alternatives, fruit and vegetables, breads and cereals, additional vegetables, and vitamin A-rich vegetables	√	—	√	—	√	N
Diversity Score (DS), USA; Caliendo et al. 1977 [36]; 2–4 y	1: dietary diversity using items consumed by 20% or more of the study samples. One point for every food item consumed from a list of 20 food items^b	—	—	—	—	√	N

Table adapted from Smithers et al. 2011 [9].
Freq: frequency; FFQ: food frequency questionnaire; N: no; Y: yes.
Core foods: foods recommended to be consumed daily for example: fruit, vegetables, dairy, meat and alternatives, and cereals [6, 15].
Noncore foods: foods recommended to be consumed in minimal amounts for example: high fat, salt, and/or sugar foods [6, 15].
^aIf portion size-quantification required, index is only useful for data collected using semiquantitative or quantitative methods.
^bUnlikely any short tool assess the same x-items.
^cNo tool assess bottle use.