title: The use of predefined diet quality scores in the context of CVD risk during urbanization in the South African Prospective Urban and Rural Epidemiological (PURE) study.
abstract: OBJECTIVE
  Urbanization is generally associated with increased CVD risk and accompanying dietary changes. Little is known regarding the association between increased CVD risk and dietary changes using approaches such as diet quality. The relevance of predefined diet quality scores (DQS) in non-Western developing countries has not yet been established.
  
  
  METHODS
  The association between dietary intakes and CVD risk factors was investigated using two DQS, adapted to the black South African diet. Dietary intake data were collected using a quantitative FFQ. CVD risk was determined by analysing known CVD risk factors.
  
  
  METHODS
  Urban and rural areas in North West Province, South Africa.
  
  
  METHODS
  Apparently healthy volunteers from the South African Prospective Urban and Rural Epidemiological (PURE) study population (n 1710).
  
  
  RESULTS
  CVD risk factors were significantly increased in the urban participants, especially women. Urban men and women had significantly higher intakes of both macro- and micronutrients with macronutrient intakes well within the recommended CVD guidelines. While micronutrient intakes were generally higher in the urban groups than in the rural groups, intakes of selected micronutrients were low in both groups. Both DQS indicated improved diet quality in the urban groups and good agreement was shown between the scores, although they seemed to measure different aspects of diet quality.
  
  
  CONCLUSIONS
  The apparent paradox between improved diet quality and increased CVD risk in the urban groups can be explained when interpreting the cut-offs used in the scores against the absolute intakes of individual nutrients. Predefined DQS as well as current guidelines for CVD prevention should be interpreted with caution in non-Western developing countries.
authors: 1Centre of Excellence for Nutrition (CEN),North West University,Potchefstroom, 2520South Africa.
authors: Robin C
authors: RC
authors: Dolman
authors: 1Centre of Excellence for Nutrition (CEN),North West University,Potchefstroom, 2520South Africa.
authors: Edelweiss
authors: E
authors: Wentzel-Viljoen
authors: 1Centre of Excellence for Nutrition (CEN),North West University,Potchefstroom, 2520South Africa.
authors: Johann C
authors: JC
authors: Jerling
authors: 2Division of Human Nutrition,Wageningen University,Wageningen,The Netherlands.
authors: Edith Jm
authors: EJ
authors: Feskens
authors: 3Africa Unit for Trans disciplinary Health Research (AUTHeR),North West University,Potchefstroom,South Africa.
authors: Annamarie
authors: A
authors: Kruger
authors: 1Centre of Excellence for Nutrition (CEN),North West University,Potchefstroom, 2520South Africa.
authors: Marlien
authors: M
authors: Pieters
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology*; D004032:Diet / Q000009:adverse effects* / Q000592:standards; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D015596:Nutrition Assessment; D018673:Nutrition Policy; D012016:Reference Values; D012307:Risk Factors; D012737:Sex Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D014505:Urban Population; D014507:Urbanization
chemical_list: D018977:Micronutrients
references: J Am Coll Cardiol. 2011 Mar 8;57(10):1210-9
references: 21371638
references: Am Heart J. 2009 Jul;158(1):1-7.e1
references: 19540385
references: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD007176
references: 18425980
references: Inflammation. 2012 Feb;35(1):221-9
references: 21384094
references: Am J Hypertens. 1999 Jan;12(1 Pt 1):84-92
references: 10075392
references: Am J Clin Nutr. 2001 Oct;74(4):479-86
references: 11566646
references: Am J Epidemiol. 2003 Jun 1;157(11):980-8
references: 12777361
references: Circulation. 2005 Dec 6;112(23):3554-61
references: 16330696
references: Public Health Nutr. 2002 Feb;5(1A):239-43
references: 12027290
references: N Engl J Med. 1994 Apr 14;330(15):1029-35
references: 8127329
references: Nutrition. 2005 Jan;21(1):39-50
references: 15661477
references: Eur J Cardiovasc Prev Rehabil. 2008 Feb;15(1):26-34
references: 18277182
references: BMJ. 1997 Jul 5;315(7099):13-7
references: 9233319
references: Public Health Nutr. 2002 Feb;5(1A):157-62
references: 12027279
references: JAMA. 2004 Sep 22;292(12):1433-9
references: 15383513
references: Public Health Nutr. 2004 Feb;7(1):29-37
references: 14972069
references: Heart. 2012 Feb;98(3):185-94
references: 21917659
references: Public Health Nutr. 2009 Dec;12(12):2473-92
references: 19335941
references: J Womens Health (Larchmt). 2003 Mar;12(2):115-22
references: 12737710
references: Public Health Nutr. 2001 Feb;4(1):53-62
references: 11315681
references: J Hum Nutr Diet. 2000 Jun;13(3):205-218
references: 12383127
references: Appl Physiol Nutr Metab. 2010 Apr;35(2):224-8
references: 20383237
references: J Am Diet Assoc. 2002 Nov;102(11):1621-30
references: 12449285
references: Nutr Res. 2011 Oct;31(10):748-58
references: 22074799
references: Public Health Nutr. 2001 Feb;4(1):63-71
references: 11315682
references: Thromb Haemost. 2011 Sep;106(3):448-56
references: 21800007
references: J Natl Cancer Inst. 1996 Nov 6;88(21):1550-9
references: 8901853
references: Br J Nutr. 2007 Feb;97(2):219-31
references: 17298689