While it is understood that poor quality diets contribute to malnutrition in all its forms, there is a lack of understanding about what kind of foods people eat globally. Measuring dietary patterns is a challenging yet critical step to inform nutrition-sensitive policies, programs, and interventions .
USAID Advancing Nutrition is working with a diverse group of partners to systematically create, country-specific diet quality monitoring tools, known as the Diet Quality Questionnaire (DQ-Q). The Global Diet Quality Project developed the DQ-Q in collaboration with Harvard University, Gallup World Poll (GWP), and GAIN. This new, rapid and easy-to-use tool collects population-level data to measure the diet characteristics that are needed to promote healthy diets. The DQ-Q responds to the need for a low-burden and cost-effective tool to collect diet quality data and measure diet quality, particularly in countries with limited resources, which can help inform policies and design interventions and programs to improve nutrition and health outcomes.
Methods used to assess diet quality are typically costly and require specialized expertise and training. However, the new DQ-Q only takes about 5 minutes to administer, is read the same way every time, and does not require implementers to have nutrition expertise or specialized training. Another key innovation of the tool is that the questionnaire uses closed lists, consisting of a limited set of sentinel foods tailored to each country's context. The DQ-Q contains 29 yes/no questions related to the consumption of 29 unique food groups, including both healthy foods and foods to limit, resulting in validated diet quality data which make assessing diet patterns simpler and less costly.
Demographics and Indicators
Population-level data obtained from the DQ-Q tool can be used to calculate numerous diet quality indicators, including the minimum dietary diversity for women, the corresponding food group diversity score, the global dietary recommendation score, and the recently updated WHO and UNICEF infant and young child feeding indicators. This tool can also be used to calculate the percentage of a population consuming foods from each of the 29 unique food groups, including healthy food groups and unhealthy foods groups that are associated with an increased risk of non-communicable diseases.
Culturally Responsive and Inclusive Adaptations
The Global Diet Quality Project team conducted over 550 key informant interviews in over 92 countries to identify the most commonly consumed foods – or sentinel foods – in each food group, in each country. The purpose of these country-specific adaptations is to ensure DQ-Qs are culturally responsive and representative of each country’s dietary patterns, and to reduce food group classification errors. Key informants in each country identified not only the appropriate sentinel foods in each food group, but also their common names if they differ from routine translations (such as “sukuma wiki” for “kale” in Kenya). In addition to the DQ-Qs for the general population, the project has adapted IYCF questions consistent with 2021 WHO and UNICEF infant and young child feeding indicators . This is the first effort to systematically adapt the list-based approach for food group level data collection, which is critical to high-quality, consistent data collection in the DHS and other national surveys.
Assessing Food Lists at the Sub-national Level
Country-adapted DQ-Q tools include foods commonly consumed in different regions and seasons within each country. Validation results from Ethiopia, Vietnam, and Solomon Islands produced nearly the same results when the DQ-Q data were compared to a 24-hour multiple pass dietary recall. The Global Diet Quality Project, and USAID and USAID Advancing Nutrition are conducting additional validation studies of the country-adapted DQ-Q to assess the degree to which they capture foods commonly consumed among sub-national populations in different countries.
Implementation of the DQ-Q
The GWP is implementing the DQ-Q in 42 countries to assess diet quality and aims to reach all GWP countries (~140) by 2024. These nationally representative data will be publicly available in the year following their collection. The Demographic and Health Survey Program is also implementing question adaptations aligned with the DQ-Q for women of reproductive age, and for IYCF. All country-adapted DQ-Q tools will be freely available as a global public good by the end of 2021, and can be easily added to existing surveys to rapidly measure and monitor the diet quality of populations.