Dietary Diversity and Its Association with Diet Quality, and Health Status of European Children, Adolescents and Adults: Results from the I.Family Study.

Abstract: Dietary diversity (DD) plays a crucial role in fostering high-quality diets, but its associationwith health outcomes, particularly body adiposity and non-communicable diseases (NCDs), isinconsistent. This may be due to a lack of a standardized method for estimating DD. Our studyinvestigates the association between two DD indices, namely the dietary diversity score (DDS) andfood variety score (FVS), and anthropometric measures, biochemical parameters, and diet qualityin a large population sample from the I.Family study across research centers in eight Europeancountries. In our cross-sectional analysis of 3035 participants, DDSs varied among countries, witha higher prevalence in the third DDS tertile among those with higher education. DDS showed apositive association with diet quality across all age groups. Higher DDS tertile individuals showedincreased fiber, fruit, and vegetable intake, greater meal frequency, and lower ultra-processed foodconsumption. No relevant biochemical differences were observed across DDS tertiles, and a higherDDS was associated with lower overweight/obesity prevalence only in adults. No significantassociations were found with FVS. Our findings emphasize the need to consider food groups fora more accurate estimation of diet quality. This aligns with studies suggesting DDS alone is notan independent risk factor for obesity in children and adolescents. Public health programs shouldprioritize food diversity to promote improved nutrition and overall well-being in communities.