DQI-5 effectively evaluates diet quality of preschoolers in SG

Using data from the GUSTO* cohort, the DQI-5 – a Diet Quality Index developed for preschool-aged children – effectively assessed the diet quality of 5-year-olds in Singapore.

“[The DQI-5] successfully determined food components that were inadequately consumed and highlighted the issue on overconsumption of food items from the total rice and alternatives and dairy product components,” said the researchers.

Food components that received high DQI-5 scores were saturated fats (10.0), total rice and alternatives (8.6), fruits (8.3), milk and dairy products (8.2), and high sugar foods (7.9). Moderately scored were meat and alternatives (6.3), sugar-sweetened drinks (4.8), and diet variety (4.0). Those that scored lowest were wholegrains (1.0), fatty acid ratio (1.7), total vegetables (1.3), and dark green leafy and orange vegetables (0.9).

Children mostly overconsumed food items from total milk and dairy products (24 percent), followed by total rice and alternatives (18 percent) and meat and alternatives (8 percent). [J Acad Nutr Diet 2023;123:299-308.e3]

“[These findings are] of concern as diets generally low in fruits, vegetables, and wholegrains are low in micronutrients and dietary fibre and has health implications, such as increased risk of childhood constipation, malnourishment, and hypercholesterolaemia. Excess consumption of refined grains, together with other foods such as animal meat, have also been associated with obesity in children and adolescents,” the researchers explained.

Overall, children with higher DQI-5 total scores were more likely to meet dietary recommendations vs those in other tertiles (p<0.001). They also had higher intake of dietary fibre, iron, vitamin A, and beta-carotene (p<0.001 for all). “Notably, most of the children in the high tertile met the dairy products, fruits and vegetables, and wholegrains recommendations,” they said.

There is still room for improvement

To date, there is a DQI for toddlers in SG but none for preschoolers, the researchers noted. “Our main aims were to develop a DQI for preschool children using the SG dietary recommendations for children aged 3–6 years and to evaluate the validity of its construct.”

They evaluated 767 5-year-old children from the GUSTO cohort (52 percent boys). Of these, 81 percent had normal BMI, 10 percent were overweight, while 6 percent were obese. Most of the kids’ mothers were of Chinese ethnicity (57 percent), while the rest were either of Malay (25 percent) or Indian descent (18 percent).

Fifty-two percent came from middle-income households. A third of children had mums with a high level of education (university and above; 35 percent). Two-thirds of kids had parents as primary caregivers; for the rest, caregiving duties were either shared (14 percent) or carried out by family members (13 percent) or domestic helpers/nannies (9 percent).

“Children whose mothers were of Malay ethnicity and had low income, an education below university and shared primary caregiver responsibilities were more likely to have lower DQI-5 scores,” the researchers noted.

Maximum possible DQI-5 score was 110 points. Total mean DQI-5 score was 61.6. According to the researchers, this “suggests that there is still capacity for improving the diets of Singapore children.”

“Overall, children with higher DQI scores were more likely to meet most dietary recommendations and have higher intake of most nutrients, suggesting that the DQI scoring system was successful in grouping the children by diet quality,” they said.

The data also underpins key dietary concerns since the findings align with literature reporting low fruit, vegetable, and wholegrain intakes in this age group. [Nutrients 2019;11:535; Am J Clin Nutr 2019;109:127-138; Nutrients 2019;11:2615]

Intervention approaches geared for children in this age group to meet dietary recommendations may be developed. The association between DQI-5 scores and potential health outcomes, such as risk of obesity and related health conditions, could be explored in future studies.