Diet Quality Indices (DQIs) fail to accommodate specific dietary patterns, dietary supplement (DS) use or adaptations to country-specific nutritional guidelines. Given the urgent transition to plant-based diets, adequate and customized tools are needed to inform on their nutritional quality.
This study aimed to develop nutrient-based DQIs to compare diet quality of omnivorous and vegetarian diets among healthy adults living in Portugal.
448 healthy omnivores (OMNI), lacto-ovo-vegetarians (LOV) and vegans (VEG) living in Portugal were included. Nutritional intake was assessed using a food frequency questionnaire and questions regarding DS use. Three DQIs were created: VeggieNutri Index, considering nutritional intake from foods and beverages, VeggieNutri+ Index which additionally considers DS use, and VeggieNutriMACRO Index considering only macronutrients from foods, beverages and DS. All indices were based on nutrient recommendations underlying the construct of the Portuguese food guide and on specific recommendations for vegetarian diets. Diet quality scores from those indices were compared across dietary patterns and against the Healthy Eating Index-2020 (HEI-2020).
VeggieNutri Index scores decreased with increasing diet strictness, with VEG showing the lowest diet quality, even after accounting for DS. While DS improved intake adequacy for certain micronutrients, including vitamin B12, key nutritional gaps remained, especially for iodine and iron. Although VeggieNutri indices' scores positively correlated with HEI-2020, the later scored higher for plant-based diets.
The VeggieNutri indices provide the first nutrient-based tools for assessing diet quality across dietary patterns. By incorporating DS, they offer a broader assessment, especially for diets prone to specific nutrient deficiencies. Our results can inform public health strategies and updates to national dietary guidelines.
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