The prevalence of childhood obesity has increased significantly
in the past three decades. Obesity carries a
number of negative medical consequences, including
cardiovascular problems and diabetes. In addition, the
dietary intake behavior of adults is strongly associated
with their dietary intake behavior as children. The authors
designed a tool to assess total diet quality in American
preschoolers: the children’s diet quality index (C-DQI).
The C-DQI can be used to measure the effectiveness of
child nutrition programs in improving overall diet quality
in children and to help target child nutrition programs to
population groups at greatest risk of poor diet quality.
The authors used dietary and sociodemographic data for
over 5,000 children ages 2-5 from the 1994-96 and 1998
Continuing Survey of Food Intake in Individuals (CSFII).
They designed the index using information on common
nutritional problems in the preschool population and
dietary intake recommendations by such organizations
as the American Academy of Pediatrics, American
Dietetic Association, and the National Academy of
Sciences. The authors selected eight components of the
index that incorporate information on the recommended
consumption levels of added sugar, total fat, saturated
fat, fruit, vegetables, grains, fruit juice, and iron.
The study found that the C-DQI values range from 16 to
70 points within the population, with an average of 46
out of 70 points. The authors tested the index’s ability to
distinguish between different levels of diet quality and
found that better diet quality (a more healthful diet)
within each of the components of the index is significantly
associated with a higher overall C-DQI score.
The analysis indicates that overall diet quality is better
for boys than for girls and for children living in metropolitan
areas than for those living in nonmetropolitan
areas. Diet quality in low-income households is better
for Hispanic children than for non-Hispanic Black or
White children and for children who attend day care or
preschool than for children who do not attend. Average
diet quality declines as children get older.
The authors also examined the trend in children’s diet
quality over time by comparing C-DQI total and component
scores among respondents to the National Food
Consumption Survey 1977-79, the CSFII 1989-91, and
the CSFII 1994-96, 1998. They found that overall diet
quality improved somewhat during the study period, but
that an increase in consumption of added sugar, excess
juice, and excess dairy and a decrease in iron consumption
caused declines in some components of diet quality.
Fat consumption, as measured in grams per day,
remained stable between 1977 and the mid- to late 1990s,
while fat consumption as a percentage of total calories
dropped 4 percent. The average number of fruit servings
consumed almost doubled between the early 1990s and
the mid- to late 1990s, with most of the rise attributable
to an increase in fruit juice consumption. The authors
noted that the intake of fat and saturated fat has not
decreased since 1977, despite public health messages
about the importance of reducing fat consumption.
The study results indicate that children’s diet quality is
influenced by sociodemographic characteristics of children
and their families. Thus, public health messages
could be targeted specifically to population groups at
greatest risk for poor diet quality. Federal programs
designed to enhance children’s diet quality, such as the
Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC) and Head Start, target
children at high risk for poor diet quality. The C-DQI
could be used to measure the impact of Federal
programs, such as WIC, on overall diet quality and on the
level of diet quality in the individual components of the
index. Using the C-DQI as an outcome measure could
help to inform policymakers in the design and implementation
of nutrition programs that will most effectively
improve children’s overall diet quality.