Development of a Diet Quality Score for Infants and Toddlers and its association with weight.

Objective: To create a Diet Quality Index Score (DQIS) for infants and toddlers and to assess its relative validity.

Design: Three DQIS were created (0-5, 8-11 and 12-24 months) based on a validated food frequency questionnaire (FFQ). Nine components were included, scored from 0 (inadequate) to 5 (adequate consumption) based on guidelines for timing of food's introduction and portion sizes; the component on breastfeeding (Yes/No) was scored (0-15). Infants 6-7 months were excluded as new foods are introduced during this period. The total score (0-55 points) was categorized as Excellent (≥45), Good (35-44), Needs improvement (25-34), and Poor (<25). Relative validity was assessed against weight status among a sample of 296 children using logistic regression.

Results: In infants 0-5 months (n=100), mean DQIS was 42.4±9.3 and 52% had 'Excellent' diets. In infants 8-11 months (n=42), mean DQIS was 36.1±7.7 and most had 'Good' diets (47.6%). Among toddlers 12-24 months (n=117), mean DQIS was 25.7±8.0 and most had 'Poor' diets (50.4%). There was a trend for a higher odd of Excessive weight in those with 'Poor' diets compared to those with 'Excellent' diets, after controlling for confounders (OR 2.01; 95% CI: 0.85, 5.18).

Conclusions: These scores could be used to assess diet quality in infants and toddlers. There was a trend for a higher odd of Excessive weight among those with 'Poor' diets. To our knowledge, this is the first algorithm for the assessment of diet quality in infants and toddlers considering intake of each food group and their portion sizes.