Development of a quality eating index and its relationship with nutritional status in adults.

Background: The implementation of Indonesia's food-based dietary guidelines (FBDG) through an index should be simulated to provide a concise overview of the diet quality of the Indonesian adult population. This study aimed to (1) develop a quality eating index to depict diet quality and (2) evaluate the performance of the instrument used to assess the association between diet quality and nutritional status among the Indonesian adult population. Methods: The quality eating index was developed based on the FBDG. The index was developed through a multi-step workflow: (1) literature review and expert panel discussion, (2) pilot study, (3) final testing and score weighing, (4) cut-off score determination, and (5) construct and criterion validation for the body mass index (BMI) and biochemical parameters such as fasting blood glucose (FBG), total cholesterol, high- and low-density lipoprotein (HDL and LDL), and triglyceride. A total of 415 subjects were randomly recruited using proportional stratified random sampling in the urban and rural communities. Results: The quality eating index was constructed of 12 food groups with a cut-off score of ≥60 indicating good and <60 showing poor/needing improvement. A low score on the quality eating index was associated with a 1.6-fold greater risk of overweight/obesity and tended to be associated with a 1.5-fold higher risk of dyslipidemia. Conclusions: The development of the quality eating index was only significantly associated with BMI. The quality eating index could potentially be used for screening for diet quality and risk of overweight/obesity among adults in urban and rural areas.