title: The development of a diet quality score for preschool children and its validation and determinants in the Generation R Study.
abstract: BACKGROUND
  Although many studies have examined health effects of infant feeding, studies on diet quality shortly after the weaning and lactation period are scarce.
  
  
  OBJECTIVE
  Our aims were to develop and evaluate a diet score that measures overall diet quality in preschool children and to examine the sociodemographic and lifestyle determinants of this score.
  
  
  METHODS
  On the basis of national and international dietary guidelines for young children, we developed a diet score containing 10 components: intake of vegetables; fruit; bread and cereals; rice, pasta, potatoes, and legumes; dairy; meat and eggs; fish; oils and fats; candy and snacks; and sugar-sweetened beverages. The total score ranged from 0 to 10 on a continuous scale and was standardized to an energy intake of 1200 kcal/d with the residual method. The score was evaluated in 3629 children participating in the Generation R Study, a population-based prospective cohort study. Food consumption was assessed with a food-frequency questionnaire (FFQ) at a median age of 13 mo.
  
  
  RESULTS
  The mean ± SD diet score was 4.1 ± 1.3. The food-based diet score was positively associated with intakes of many nutrients, including n-3 (ω-3) fatty acids [FAs; 0.25 SD increase (95% CI: 0.22, 0.27) per 1 point increase in the diet score], dietary fiber [0.32 (95% CI: 0.30, 0.34)], and calcium [0.13 (95% CI: 0.11, 0.16)], and was inversely associated with intakes of sugars [-0.28 (95% CI: -0.31, -0.26)] and saturated fat [-0.03 (95% CI: -0.05, -0.01)]. A higher diet score was associated with several health-conscious behaviors, such as maternal folic acid supplement use during pregnancy, no smoking during pregnancy, and children watching less television.
  
  
  CONCLUSIONS
  We developed a novel food-based diet score for preschool children that could be applied in future studies to compare diet quality in early childhood and to investigate associations between diet in early childhood and growth, health, and development.
authors: The Generation R Study Group and Departments of Epidemiology trudy.voortman@erasmusmc.nl.
authors: Trudy
authors: T
authors: Voortman
authors: Departments of Epidemiology.
authors: Jessica C
authors: JC
authors: Kiefte-de Jong
authors: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands; and.
authors: Anouk
authors: A
authors: Geelen
authors: Department of Epidemiology, University of Michigan, Ann Arbor, MI.
authors: Eduardo
authors: E
authors: Villamor
authors: Pediatrics, and.
authors: Henriëtte A
authors: HA
authors: Moll
authors: Pediatrics, and.
authors: Johan C
authors: JC
authors: de Jongste
authors: Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Hein
authors: H
authors: Raat
authors: Departments of Epidemiology.
authors: Albert
authors: A
authors: Hofman
authors: The Generation R Study Group and Departments of Epidemiology Pediatrics, and.
authors: Vincent W V
authors: VW
authors: Jaddoe
authors: Departments of Epidemiology.
authors: Oscar H
authors: OH
authors: Franco
authors: Departments of Epidemiology.
authors: Edith H
authors: EH
authors: van den Hooven
mesh_terms: D002675:Child, Preschool; D004032:Diet / Q000592:standards*; D019587:Dietary Supplements; D002149:Energy Intake; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D015438:Health Behavior; D006801:Humans; D007223:Infant; D008019:Life Style; D016014:Linear Models; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage; D009426:Netherlands; D018673:Nutrition Policy; D011446:Prospective Studies; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D015525:Fatty Acids, Omega-3; D018977:Micronutrients; D005492:Folic Acid
keywords: birth cohort; diet index; dietary pattern; healthy diet; infants; predictors; preschoolers; sociodemographic determinants; toddlers; validation