Development of a Diet Quality Score for Japanese and Comparison With Existing Diet Quality Scores Regarding Inadequacy of Nutrient Intake

J Nutr. 2023 Mar;153(3):798-810. doi: 10.1016/j.tjnut.2022.11.022. Epub 2022 Dec 24.


Background: Few studies have explored optimal diet quality scores in Japan.

Objectives: We developed a Diet Quality Score for Japanese (DQSJ) and examined the associations of DQSJ and existing diet quality scores with inadequacy of nutrient intake in Japanese adults.

Methods: Candidate components of the DQSJ were extracted from well-established diet quality scores: Healthy Eating Index-2015 (HEI-2015), Alternate Healthy Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet score (AMED), and Dietary Approaches to Stop Hypertension (DASH). From candidates, we selected the components of the DQSJ, considering potential health effects of the components (from the Global Burden of Disease Study) and dietary intake in Japan. The DQSJ included 10 components: fruits, vegetables, whole grain, dairy, nuts, legumes, fish, red and processed meat, sugar-sweetened beverages, and sodium. We calculated the DQSJ, HEI-2015, AHEI-2010, AMED, DASH, and Japanese Food Guide Spinning Top score (JFGST) based on 4-d dietary records of 392 Japanese aged 20-69 y. Inadequate intakes of 21 nutrients were assessed using the DRIs for Japanese. Logistic regression was used to examine the prevalence of inadequate nutrient intake according to quartiles of the scores.

Results: All examined scores except the JFGST were moderately to strongly correlated with each other (Spearman correlation coefficients: 0.52-0.84). They were inversely associated with the prevalence of inadequate intake of most nutrients (n = 16 for DQSJ and HEI-2015, n = 13 for AHEI-2010 and DASH, n = 17 for AMED, compared with n = 4 for JFGST). AMED was also positively associated with the prevalence of inadequate sodium intake, whereas no such associations were observed for the other scores.

Conclusions: Similar to HEI-2015, AHEI-2010, and DASH, the DQSJ was generally associated with the low prevalence of inadequate intake of most nutrients in Japanese adults. Further evaluations against biomarkers and health outcomes are warranted.

Keywords: diet quality index; dietary guidelines; dietary pattern; healthy diet; nutrient adequacy; quality of diet.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diet
  • Diet, Healthy*
  • Diet, Mediterranean
  • Dietary Approaches To Stop Hypertension
  • East Asian People*
  • Eating
  • Energy Intake
  • Humans