[Index of healthy diet for assessing regional dietary patterns of the population of the Russian Federation].

Abstract

Dietary intake assessment involves management of dozen parameters related to energy and nutrient intake. The number of parameters increase significantly when it is necessary to assess dietary intake of foods, food groups and its combinations, cooking methods of complex recipe dishes, other dietary factors. Tools known as Diet Quality Indices (DQI) and a specific subgroup - Indices of healthy diet (IHD) have been proposed for the aggregated assessment of dietary factors diversities. These indices provide a quantitative measure of dietary intake in accordance with established principles and guidelines for healthy eating (the R-IHD developed by us in the original publications was incorrectly translated into English as HEI). The aim of this study was to validate the application of the integrated Russian Index of healthy diet (R-IHD) in the assessment of regional features of diet of the population in the Russian Federation.

Material and methods: Microdata on the actual consumption of nutrients and major food groups by the adult population have been used. These data were obtained from a cross-sectional dietary survey of 45.000 households conducted by Rosstat in all constituent entities of the Russian Federation in 2023 using the 24-hour recall method. The data processing and statistical analysis were performed using IBM SPSS Statistics v.20.0 (USA), which utilized a specially developed algorithm for digital transformations of a set of dietary intake microdata for multi-level analysis of nutrient and food group consumption and to update the design of the R-IHD.

Results: A quintile distribution of individual R-IHD scores among respondents in Federal Districts (FDs) of the Russian Federation showed that the highest percentage of R-IHD scores are valid for quintiles 4-5 in the Ural, Southern, and North Caucasus FDs. The same time, in the Northwestern, Siberian, and Far Eastern FDs, the highest shares of R-IHD are accumulated in the lowest 1-2 quintiles of R-IHD scores. Statistical analysis of dietary patterns across R-IHD quintiles of the entire adult sample showed that daily energy intake is significantly lower in the 5th quintile compared to the 1st one. Distribution of the individual food and nutrient intake by quintile have different attributes. The intake of cereals, dairy products, fish and seafood, vegetables, and fruits by adults is significantly higher in the 5th R-IHD quintile when calculated per 1000 kcal, while in absolute values the intake (g/day) of cereals, fish and seafood doesn't change. At the same time, consumption of meat and poultry, sausages, total fat, saturated fatty acids, cholesterol, added sugar and salt is significantly lower in the 5th quintile of the R-IHD regardless the calculation method. The 1st and 10th distribution deciles of the average regional R-IHD values were selected to analyze the regional patterns in the relationship between diet and R-IHD. Each deciles contains eight regions with the lowest or highest average R-IHD scores. The analysis results in these groups for most food items are consistent with the analysis of the distribution of individual R-IHD scores by quintile, though differences were also identified. The dietary content of cereals, meat and poultry, vegetables and fruits is significantly higher in the regions with high R-IHD scores, while the content of all critical nutri ents (% of energy) is significantly lower than in regions with low average R-IHD scores. However, in the regions with high average R-IHD scores, dair y products' content in milk equivalents is lower than in the regions with low R-IHD scores. R-IHD high scores both in the 5th quintile of the individual R-IHD distribution and in the regional distribution are associated with a higher proportion (%) of energy coming from cereals, vegetables, legumes, fruits, first courses, the same time with lower percentage of energy coming from fats, sugar and confectionery, potato dishes, alcoholic beverages.

Conclusion: Convincing evidence has been identified for the validity of R-IHD in the asses sment of the diet quality working both with the individual R-IHD parameters and the average regions R-IHD values. This suggests the potential for using a validated digital R-IHD score and its components to investigate the relationship between dietary patterns and population health, using statistical regional indicators of morbidity and mortality from chronic non-communicable diseases.