Increased research on effectiveness and efficiency of lifestyle programs to manage cardio metabolic risk conditions has identified a need for brief diet assessment tools to evaluate initial diet at baseline and to compare counseling results among client groups over time and across programs. In particular, Diet Quality (DQ) indices, such as versions of the Healthy Eating Index (HEI) are useful where the focus of treatment is to modify foods or the whole eating pattern. They have advantages in that population data are available for comparison, they focus on those aspects of eating patterns that together are associated with reduced health risk, and they generate a summary score.

Current limitations are that a nutrient analysis must also be available to assess sodium, fat, sugar and total caloric intake, thus feasibility in clinical practice remains an issue. This mini-review examines progress in development of brief diet assessment and DQ tools in dietary counseling or lifestyle education programs for individuals with cardio metabolic risk conditions. To improve comparability among published studies, it is recommended that researchers and program evaluators consider using HEI or other current DQ tools relevant to their target population in addition to traditional diet assessment methods. New work is needed to further adapt current DQ tools for validity and feasibility of completion in both clinical counselling and population surveillance contexts.

Diet assessment is a core activity in traditional clinical nutrition care/diet counseling process at baseline and in follow-up. An initial diet assessment, along with information from lifestyle, medical, anthropometric and laboratory assessments guides selection and delivery of the required nutrient/food intervention. Diet assessment is also important for evaluation of outcomes achieved with each client, in local program evaluation and in implementation research. Measurement error and other limitations of current diet assessment methods are well-recognized and longstanding challenges in dietetics; increased research on healthy or digital interventions, genetic studies in nutrient metabolism, and population epidemiological studies hold hope for development of more accurate and valid approaches. In our opinion, among the most promising approaches to emerge to date is the use of Diet Quality (DQ) indices, such as the Healthy Eating Index (HEI), especially in treatment of cardio metabolic risk (CMR) conditions.

CMR conditions and diseases are a major and growing health burden in many countries, as obesity continues to increase worldwide. Excess body weight is associated with heterogeneous metabolic effects and Cardiovascular Disease (CVD) remains a prominent clinical disease. Adverse metabolic effects of excess body weight become more prominent in middle age and are variously defined in health systems as specific conditions, such as prediabetes, type 2 diabetes, or hypertension, or risk scores such as the Framingham 10-year risk score. Metabolic syndrome is characterized by three or more indicators including higher waist circumference, higher blood pressure, dyslipidemia characterized by low high-density lipoprotein and elevated triglyceride levels, and elevated glucose levels. The various terms describe overlapping populations. Fortunately, significant progress has been made in demonstrating the benefits of personalized lifestyle counselling in large clinical and community trials, and several countries (UK, US, Japan) have undertaken large projects to start to address prediabetes and/or CMR.

With Regards,
Joseph Kent
Journal Manager
Journal of Clinical Nutrition & Dietetics