title: Healthy Food Intake Index (HFII) - Validity and reproducibility in a gestational-diabetes-risk population.
abstract: The aim was to develop and validate a food-based diet quality index for measuring adherence to the Nordic Nutrition Recommendations (NNR) in a pregnant population with high risk of gestational diabetes (GDM).
  
  
  
  This study is a part of the Finnish Gestational Diabetes Prevention Study (RADIEL), a lifestyle intervention conducted between 2008 and 2014. The 443 pregnant participants (61 % of those invited), were either obese or had a history of GDM. Food frequency questionnaires collected at 1st trimester served for composing the HFII; a sum of 11 food groups (available score range 0-17) with higher scores reflecting higher adherence to the NNR.
  
  
  
  The average HFII of the participants was 10.2 (SD 2.8, range 2-17). Factor analysis for the HFII component matrix revealed three factors that explained most of the distribution (59 %) of the HFII. As an evidence of the component relevance 9 out of 11 of the HFII components independently contributed to the total score (item-rest correlation coefficients <0.31). Saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, sucrose, and fiber intakes (among other nutrients) showed linearity across the HFII categories (P ≤ 0.030 for all nutrients tested); the higher the HFII, the closer the nutrient intake to the recommended intake level. Educational attainment (P = 0.0045), BMI (P = 0.0098), smoking (P = 0.007), and leisure time physical exercise (P = 0.038) showed linearity across the HFII categories. Intra-class correlation coefficient for the HFII was 0.85 (CI 0.79, 0.90).
  
  
  
  The HFII components reflect the food guidelines of the NNR, intakes of relevant nutrients, and characteristics known to vary with diet quality. It largely ignores energy intake, its components have independent contribution to the HFII, and it exhibits reproducibility. The main shortcomings are absence of red and processed meat component, and the validation in a selected study population. It is suitable for ranking participants according to the adherence to the NNR in pregnant women at high risk of GDM.
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland. jelena.meinila@helsinki.fi.
authors.forename: Jelena
authors.identifier: 0000-0002-6377-1377
authors.initials: J
authors.lastname: Meinilä
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland.|Folkhälsan Research Centre, University of Helsinki, Helsinki, Finland.
authors.forename: Anita
authors.initials: A
authors.lastname: Valkama
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Saila B
authors.initials: SB
authors.lastname: Koivusalo
authors.affiliation: Department of Obstetrics and Gynecology, South-Karelia Central Hospital, Lappeenranta, Finland.
authors.forename: Beata
authors.initials: B
authors.lastname: Stach-Lempinen
authors.affiliation: Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Lindström
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland.|Department of General Practice and Primary Health Care, University of Eastern Finland, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, Tukholmankatu 8 B, Biomedicum Helsinki, 00014, Helsinki, Finland.|Folkhälsan Research Centre, University of Helsinki, Helsinki, Finland.
authors.forename: Johan G
authors.initials: JG
authors.lastname: Eriksson
authors.affiliation: Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: Maijaliisa
authors.initials: M
authors.lastname: Erkkola
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000517:prevention & control*; D004032:Diet; D004034:Diet Surveys; D002149:Energy Intake; D005260:Female; D005387:Finland; D006801:Humans; D039382:Maternal Nutritional Physiological Phenomena; D009752:Nutritional Status; D010349:Patient Compliance; D011247:Pregnancy; D011295:Prenatal Care; D015203:Reproducibility of Results
keywords: Diet quality index; Dietary pattern; Gestational diabetes; Nordic nutrition recommendations; Nutrition and pregnancy; Validation