TABLE 1.
Characteristics of the studies included, evaluating the adherence to healthy and/or sustainable dietary patterns and associated outcomes in children and adolescents1
| Instrument | Authors (reference) | Country | Study design | Sample size, age, and sex | Adherence level | Health outcomes associated with adherence level | Quality assessment score |
|---|---|---|---|---|---|---|---|
| KIDMED | Bonaccorsi et al. (85) | Italy | Cross-sectional study | n = 3146 14 y old 47.8% males | Score range: −4 to 12. Mean ± SD: 5.91 ± 2.40.High adherence: 24.8%.Medium adherence: 56.4%.Poor adherence: 18.8% | Less adherence to the KIDMED was related to preobesity and obesity. | 62 |
| Grassi et al. (127) | Italy | Cross-sectional study | n = 2826 8 y old 55.7% males | Score range: −4 to 12.Mean ± SD: 4.93 ± 2.30.High adherence: 13.5%.Medium adherence: 59.6%.Poor adherence: 27% | — | 32 | |
| Ríos-Hernández et al. (117) | Spain | Case–control study | n = 1306 16 y old 56.7% males | Score range: −4 to 12.ADHD cases:Mean ± SD: 6.2 ± 2.0.High adherence: 30%.Medium adherence: 58.3%.Poor adherence: 11.7%.Control cases:Mean ± SD: 8.1 ± 1.8.High adherence: 63.3%.Medium adherence: 36.7%.Poor adherence: 0.0% | Lower adherence to the KIDMED index was associated with ADHD diagnosis. | 63 | |
| Rosi et al. (128) | Italy | Cross-sectional study | n = 40911 14 y old 54% males | Score range: −4 to 12.Mean ± SD: 6.0 ± 2.3.High adherence: 12%.Medium adherence: 60%.Poor adherence: 28% | — | 52 | |
| Ojeda-Rodríguez et al. (74) | Spain | RCT 2 months follow-up | n = 1077 16 y old 37% males | Score range: −4 to 12.Mean ± SD at baseline: 5.2 ± 1.8 (usual care group); 7.2 ± 1.6 (intensive care group).Mean (95% CI) changes within group after 8 wk: 2.0 (0.9, 3.0) (usual care group); 3.0 (2.5, 3.5) (intensive care group) | — | High risk of bias4 | |
| Grao-Cruces et al. (129) | Spain | Cross-sectional study | n = 180812 16 y old 51.3% males | Score range: −4 to 12.Mean ± SD: 6.44 ± 2.38 (male); 5.95 ± 2.42 (female) | — | 72 | |
| Yüksel et al. (56) | Turkey | Cross-sectional study | n = 85915 9 ± 1.3 y old 81.4% male | High adherence: 13%.Medium adherence: 54.6%.Poor adherence: 32.4% | There was no statistically significant relation between adherence to the KIDMED index and obesity and Night Eating Syndrome.5 | 42 | |
| Arriscado et al. (97) | Spain | Cross-sectional study | n = 32111 12 y old 50.8% male | Score range: −4 to 12.Mean ± SD: 7.2 ± 1.9.High adherence: 46.8%.Medium adherence: 48.6%.Poor adherence: 4.7% | There was no statistically significant relation between KIDMED index and BMI.5 | 42 | |
| Gómez et al. (70) | Spain | RCT 15 months follow-up | n = 22508 10 y old 48.2% male | Score range: −4 to 12.Mean ± SD at baseline: 6.7 ± 2.5 (intervention); 7.0 ± 2.3 (control).Mean ± SD at follow-up: 6.7 ± 2.4 (intervention); 6.6 ± 2.4 (control) | Promoting adherence to the KIDMED index had no significant effect on the BMI z score, and incidence of general and abdominal obesity. | High risk of bias4 | |
| Muros et al. (73) | Chile | Cross-sectional study | n = 51510 6 ± 0.5 y old 50.5% male | Score range: −4 to 12.Mean ± SD: 6.1 ± 2.5.High adherence: 22.9%.Medium adherence: 67.6%.Poor adherence: 9.5% | Adherence to the KIDMED index was consistently and negatively associated with BMI, percentage of body fat, subscapular skinfold thickness, and WC.5 | 52 | |
| Monjardino et al. (55) | Portugal | Cohort study 4 y follow-up | n = 1023 13 and 17 y old (KIDMED adherence at age 13 y and association with bone mineral density at age 17 y) 46.3% male | Score range: −4 to 12.Mean ± SD at 13 y: 5.2 ± 2.0 (male); 5.1 ± 2.1 (female) | Only among 13-y-old males, KIDMED index was significantly associated with higher bone mineral density at 17 y. No associations were found in relation to BMI at both ages. | 76 | |
| Rosi et al. (76) | Italy | Cross-sectional study | n = 6909 11 y old 48.3% males | Mean ± SD: 6.5 ± 2.2High adherence: 35.5%.Medium adherence: 55.2%.Poor adherence: 9.3% | No evidence was found of an association between the KIDMED index and BMI.5 | 52 | |
| Grigoropoulou et al. (116) | Greece | Cross-sectional study | n = 112510 12 y old 47% males | Score range: −4 to 12.Mean ± SD: 4.7 ± 1.9 (urban areas); 5.3 ± 2.0 (rural areas) | A 1-unit increase in the KIDMED index was associated with 16% lower likelihood of having asthma symptoms. | 62 | |
| Torres-Luque et al. (130) | Spain | Cross-sectional study | n = 3633 5 y old 54% males | Male:High adherence: 51.3%.Medium adherence: 48.7%.Poor adherence: 0.0%.Female:High adherence: 44.8%.Medium adherence: 50.0%.Poor adherence: 5.2% | — | 42 | |
| Korkmaz and Kabaran (86) | Turkey | Cross-sectional study | n = 9006 9 y old 60.5% males | Score range: −4 to 12.Mean ± SD: 5.0 ± 2.45.High adherence: 18.7%.Medium adherence: 45.7%.Poor adherence: 35.7% | An inverse correlation was found between KIDMED index and body weight, BMI, and waist and neck circumferences.5 | 72 | |
| Obradovic Salcin et al. (131) | Croatia | Cross-sectional study | n = 2605 6 y old 51.5% males | High adherence: 70.0%.Medium adherence: 24.0%.Poor adherence: 6.0% | — | 72 | |
| Bacopoulou et al. (50) | Greece | Cross-sectional study | n = 161012 17 y old 41.7% males | Score range: −4 to 12.Mean ± SD: 5.6 ± 2.4 (baseline); 5.8 ± 2.4 (follow-up) | Waist of circumference decreased as the KIDMED score increased.5 | 72 | |
| Mistretta et al. (87) | Italy | Cross-sectional study | n = 164311 16 y old 53.9% males | Score range: −4 to 12.Mean ± SD: 4.3 ± 2.1.High adherence: 9.1%.Medium adherence: 61.0%.Poor adherence: 29.9% | An inverse correlation was found between the KIDMED index and BMI, WC, and fat mass. No relation with blood pressure was found. | 62 | |
| Magriplis et al. (75) | Greece | Cross-sectional study | n = 45810 12 y old 49% males | Score range: −4 to 12.Mean ± SD: 3.78 ± 2.20 | — | 72 | |
| Calmeiro and Pereira (132) | Portugal | Cross-sectional study | n = 7827 9 ± 1.4 y old 51.8% males | Score range: −4 to 12.Mean ± SD: 5.88 ± 2.23 | — | 62 | |
| López-Gil et al. (88) | Spain | Cross-sectional study | n = 3706 13 y old 55.1% males | Score range: −4 to 12.Mean ± SD: 6.1 ± 2.1 (male); 6.3 ± 2.0 (female) | KIDMED < 3.8: positive association with adiposity. KIDMED > 9.3: negative association with adiposity | 62 | |
| Garcia-Hermoso et al. (115) | Colombia | Cross-sectional study | n = 11408 12 y old69.6% males | Score range: −4 to 12.Mean ± SD: 6.42 ± 0.12 (male); 6.39 ± 0.16 (female) | Adherence to the KIDMED index was negatively associated with systolic and diastolic arterial pressure.5 | 62 | |
| Grosso et al. (89) | Italy | Cross-sectional study | n = 113513 16 y old 45% males | Score range: −4 to 12.Mean ± SD: 4.9 ± 2.3 (male); 5.0 ± 2.1 (female) | Lower adherence to the KIDMED index was associated with being obese. | 72 | |
| López-Gil et al. (133) | Spain | Cross-sectional study | n = 3706 13 y old 55.1% males | High adherence: 25.9%.Medium adherence: 65.1%.Poor adherence: 8.9% | — | 72 | |
| Archero et al. (98) | Italy | Cross-sectional study | n = 6696 16 y old 48.4% males | High adherence: 19.6%.Medium adherence: 63.7%.Poor adherence: 16.7% | KIDMED score was positively associated with height. Adherence to the KIDMED index was not associated with the risk of overweight/obesity. | 72 | |
| Esteban-Cornejo et al. (134) | Spain | Cross-sectional study | n = 137112.0 ± 2.5 y old 50% males | Score range: −4 to 12.Mean ± SD: 6.66 ± 2.29.High adherence: 37%.Medium adherence: 55%.Poor adherence: 8% | — | 62 | |
| Mazaraki et al. (51) | Greece | Cross-sectional study | n = 36512 17 y old 58% males | High adherence: 6.8%.Medium adherence: 51.2%.Poor adherence: 42% | Adherence to the KIDMED index was positively related to BMI, WC, and systolic blood pressure and negatively associated with albuminuria.5 | 62 | |
| Costarelli et al. (36) | Greece | Cross-sectional study | n = 3962 12 y old 47.5% males | Score range: −4 to 12.Mean ± SD: 6.54 ± 2.44.High adherence: 34.8%.Medium adherence: 56.5%.Poor adherence: 8.6% | — | 72 | |
| Marques et al. (77) | Portugal | Cross-sectional study | n = 8919 11 y old 51% males | High adherence: 77.6%.Medium adherence: 13.7%.Poor adherence: 0.4% | — | 52 | |
| Roccaldo et al. (99) | Italy | Cross-sectional study | n = 17408 9 y old 51.7% males | High adherence: 5%.Medium adherence: 62.5%.Poor adherence: 32.8% | The KIDMED index did not differ significantly according to BMI. 5 | 52 | |
| Chacón-Cuberos et al. (135) | Spain | Cross-sectional study | n = 105914 16 y old 49.4% males | High adherence: 76.8%.Medium adherence: 22.7%.Poor adherence: 0.6% | — | 62 | |
| Azekour et al. (100) | Morocco | Cross-sectional study | n = 36849 8 ± 2.1 y old 48.7% males | High adherence: 40%.Medium adherence: 57.9%.Poor adherence: 2.1% | No relation was found between the KIDMED index and BMI. | 72 | |
| Martin-Calvo et al. (71) | Spain | Cohort study 2–3 y of follow-up | n = 10,9188 15 y old 45% males | At baseline:High adherence: 0.8%.Medium adherence: 17.8%.Poor adherence: 81.4%.Follow-up: 2-point increase in the score. | A 2-point increase in the KIDMED index was negatively associated with BMI. | 66 | |
| Bawaked et al. (72) | Spain | Cohort study 15 months follow-up | n = 16398 10 y old 51.8% males | Score range: −4 to 12.At baseline:Mean ± SD: 6.8 ± 2.4.High adherence: 40.4%.Medium adherence: 50.0%.Poor adherence: 9.6% | — | 66 | |
| Labayen Goñi et al. (101) | Spain | Cross-sectional study | n = 6194 7 ± 0.8 y old 51.4% males | High adherence: 62% | Higher KIDMED index was significantly related to lower WC.No significant association was observed between KIDMED index and BMI. | 62 | |
| Sahingoz and Sanlier (136) | Turkey | Cross-sectional study | n = 89010 14 y old 52.1% males | High adherence: 22.9%.Medium adherence: 59.2%.Poor adherence: 17.9% | — | 52 | |
| del Mar Bibiloni et al. (52) | Spain | Cross-sectional study | n = 123112 17 y old 43.4% males | High adherence: 28.4%.Medium adherence: 55.9%.Poor adherence: 15.7% | — | 72 | |
| Zervaki et al. (57) | Greece | Cross-sectional study | n = 40014 17 y old 49.5% males | Score range: −4 to 13.Mean ± SD: 5.1 ± 1.8 | — | 52 | |
| Krece Plus test | Delgado Floody et al. (137) | Chile | Cross-sectional study | n = 634Female: 11.9 ± 0.8 y old Male: 12.0 ± 0.9 y old 55.5% males | High adherence: 35%.Medium adherence: 47.5%.Poor adherence: 15.9% | — | 62 |
| MDS | Arouca et al. (58) | European countries (Austria, Belgium, France, Germany, Greece Hungary, Italy, Spain, and Sweden) | Cross-sectional study | n = 56213 17 y old 46.8% males | Score range: 0–8.Mean ± SD: 4.15 ± 1.45 | Greater adherence to the MDS was associated with lower blood C-reactive protein concentrations. | 62 |
| Winpenny et al. (54) | United Kingdom | Cohort study 3 y follow-up | n = 60314 and 17 y old 40% males | Score range: 0–8.Mean ± SD at 14 y: 4.88 ± 1.78 | The MDS was not associated with depressive symptoms. | 76 | |
| Martínez et al. (53) | Spain | Cross-sectional study | n = 1231 12–17 y old 56.9% males | Low adherence: 44.1% (% of adherence below the lower quartile).High adherence: 5.4% (% of adherence above the upper quartile). | — | 72 | |
| Jennings et al. (78) | England | Cross-sectional study | n = 17009 10 y old 43.8% males | Score range: 0–8.Mean ± SD: 4.1 ± 1.6. | The MDS was not associated with BMI, WC, and waist-to-height ratio. | 52 | |
| Rivas et al. (68) | Spain | Cross-sectional study | n = 1326 8 y old43% males | Score range: 1–13.Mean: 8.24. | — | 42 | |
| fMDS | Tognon et al. (37) | European countries (Sweden, Germany, Hungary, Italy, Cyprus, Spain, Belgium, and Estonia) | Cohort study 2 y follow-up | n = 16,2202 9 y old 50.9% males | fMDS>3:Sweden: 56.7%.Italy: 37.5%.Germany: 35.1%.Spain: 31.8%.Hungary: 32.2%.Belgium: 32.7%.Estonia: 26.3%.Cyprus: 24.2% | In a pooled analysis, higher scores of the fMDS were inversely associated with overweight, obesity, and percentage of fat mass | 76 |
| Mediterranean Adequacy Index (MAI) | Pastor et al. (138) | Spain | Cross-sectional study | n = 1306 12 y old 53% males | Score ≥ 0.Mean ± SD: 0.87 ± 0.4666 | — | 72 |
| Italian Mediterranean Index (IMI) | Zani et al. (139) | Italy | Cross-sectional study | n = 11646 8 y old 50.8% males | High adherence: 10.9%.Medium adherence: 30.1%.Poor adherence: 59% | — | 42 |
| Mediterranean-Style Dietary Pattern Score (MSDPS) | Neshatbini Tehrani et al. (49) | Iran | Cross-sectional study | n = 29716.1 ± 0.9 y old 100% females | Score: 0–100.Median [IQR]: 15.2 [11.9–19.5].High adherence: 51.2%.Low adherence: 48.8% | — | 72 |
| DQI-I adapted to Mediterranean Diet | Mariscal-Arcas et al. (69) | Spain | Cross-sectional study | n = 31908 15 y old 49.4% males | Score range: 0–100.Mean ± SD: 58.37 ± 7.74 | — | 52 |
| Silva et al. (66) | Portugal | Cross-sectional study | n = 66910 17 y old 50% males | Score range: 0–100.Mean ± SD: 49.7 ± 7.0 | — | 52 | |
| BSDS | Eloranta et al. (81) | Finland | Cross-sectional study | n = 4026 8 y old 50.7% males | Score range: 0–25.Mean ± SD: 11.5 ± 4.4 (male); 12.0 ± 4.3 (female). | BSDS was not associated with cardiometabolic risk. Higher BSDS score was associated with lower concentration of plasma HDL cholesterol in females. | 52 |
| SEAD score | Moreira et al. (47) | Portugal | Cross-sectional study | n = 46816.5 ± 0.9 y old 41.7% males | High adherence: 57.1%.Low adherence: 42.9% | Low adherence to the SEAD was associated with higher values of a metabolic risk score. Fit adolescents with high adherence to the SEAD showed the lowest prevalence of high metabolic risk score | 52 |
| Agostinis-Sobrinho et al. (113) | Portugal | Cross-sectional study | n = 437 Mean: 16.5 y old 41.1% males | Score range: 0–8.Mean ± SD: 4.74 ± 1.88 | Adolescents with low adherence to the SEAD had the highest odds of having a high cardiometabolic risk score. | 72 | |
| Diet Score based on the Norwegian Health Directorate | Handeland et al. (140) | Norway | Cross-sectional study | n = 47214 15 y old 47.5% males | High adherence: 24.8%.Medium adherence: 47.9%.Poor adherence: 26.9% | — | 62 |
| HuSKY | Truthmann et al. (46) | Germany | Cross-sectional study | n = 519812 17 y old 50.9% males | Score range: 0–100.Mean: 53.1 | A negative association was found between the HuSKY and homocysteine concentrations. | 72 |
| Egmond-Fröhlich et al. (62) | Germany | Cross-sectional study | n = 11,6766 17 y old No information on sex % | Score range: 0–100.Mean ± SD: 55.0 ± 11.0 | The HuSKY score had a negative association with ADHD symptoms. | 72 | |
| Diet Quality Index for Children | Huybrechts et al. (141) | Belgium | Cross-sectional study | n = 1692 5–6.5 y old No information on sex % | Score range: −25 to 100.Mean ± SD: 72.0 ± 11.0 | — | 52 |
| DQI-A | Vyncke et al. (41) | European countries (Austria, Belgium, France, Germany, Greece, Italy, Spain, and Sweden) | Cross-sectional study | n = 180712.5–17.5 y old 47.4% males | Score range: 0–100.Mean ± SD: 49.0 ± 17.0 (male); 53.3 ± 15.9 (female) | — | 72 |
| DQI-A adapted to Brazil | Ronca et al. (65) | Brazil | Cross-sectional study | n = 71,533 12–17 y old 50.2% males | Score range: −33 to 100.Mean ± SD: 19.0% ± 6.3% (male); 14.8% ± 6.1% (female) | — | 72 |
| Dietary Quality Score for Ireland | Keane et al. (142) | Ireland | Cross-sectional study | n = 85619 y old 51.2% males | Score range: −5 to 25.Mean ± SD: 9.4 ± 4.2 | — | 72 |
| CIDQ | Röytiö et al. (40) | Finland | Cohort study, cross-sectional analysis | n = 4002 6 y old 48% males | High adherence: 19.8%.Medium adherence: 58.0%.Poor adherence: 22.2% | The CIDQ score was associated with lower total cholesterol concentrations.5 | 66 |
| SHEIA 2015 | Moraeus et al. (94) | Sweden | Cross-sectional study | n = 2905Mean 12 y old 44% males | High adherence: 30.0%.Medium adherence: 48.8%.Poor adherence: 24.4% | No association was found between the SHEIA 2015 and BMI. | 72 |
| RADDS | Moraeus et al. (94) | Sweden | Cross-sectional study | n = 2905Mean: 12 y old 44% males | High adherence: 17.9%.Medium adherence: 56.8%.Poor adherence: 25.3% | RADDS score was inversely associated with BMI | 72 |
| Finish Children Healthy Eating Index (FCHEI) | Eloranta et al. (143) | Finland | Cross-sectional study | n = 3676 8 y old 51.2% males | Score range: 5–40.Mean ± SD: 23.0 ± 7.0 | — | 72 |
| DASH | Robson et al. (80) | San Diego | Cross-sectional study | n = 6986 12 y old 49.3% males | Score range: 0–80.Mean ± SD: 43.4 ± 9.0 | — | 72 |
| Monjardino et al. (55) | Portugal | Cohort study 4 y follow-up | n = 1023 13 and 17 y old 46.3% males | Score range: 8–40.Mean ± SD: 23.7 ± 4.5 (male); 23.7 ± 4.5 (female) | No association was found between the DASH score and BMI and bone mineral density. | 76 | |
| Bricarello et al. (59) | Brazil | Cross-sectional study | n = 71,553 12–17 y old 44.5% males | Score range: 8–40.Mean: 15.7.Minimum: 5.4.Maximum: 34.5 | No associations were found between the DASH score and hypertension. | 72 | |
| Asghari et al. (60) | Iran | Cohort study 3.6 y follow-up | n = 425 10–17 y old 42% males | Score range: 8–40.Baseline mean ± SD: 24.1 ± 4.3 | High adherence to the DASH diet was associated with lower levels of metabolic syndrome, hypertension, high fasting plasma glucose, and abdominal obesity. | 56 | |
| Eloranta et al. (81) | Finland | Cross-sectional study | n = 4026 8 y old 50.7% males | Score range: 0–80.Mean ± SD: 20.3 ± 4.4 (male); 21.8 ± 4.2 (female) | High adherence to the DASH diet was associated with lower concentrations of serum insulin and triglyceride in males and a lower concentration of plasma HDL cholesterol in females. | 52 | |
| Rostami et al. (48) | Iran | Cross-sectional study | n = 488 12–17 y old No information on sex % | 20% was in the first quintile of adherence to the DASH diet. | High adherence to the DASH diet was associated with lower levels of insomnia. | 72 | |
| Najafi et al. (79) | Iran | Cross-sectional study | n = 4076 12 y old 47.4% males | 33.4%: lowest tertile.33.2%: highest tertile | A higher adherence (highest tertile) to the DASH score was significantly related to lower levels of systolic blood pressure. | 72 | |
| Pérez-Gimeno et al. (82) | Spain | Cross-sectional study | n = 6875 16 y old No information on sex % | Score range: 7–35.Males:Mean ± SD: 17.3 ± 4.7 (prepubertal); 17.8 ± 5.3 (pubertal).Females:Mean ± SD: 18.5 ± 5.1 (prepubertal); 19.4 ± 4.7 (pubertal) | — | 72 | |
| HLD Index | Manios et al. (114) | Greece | Cross-sectional study | n = 72910–12 y old No information on sex % | Score range: 0–40.Mean ± SD: 20.0 ± 4.4. | <3.16 points → 20.9% of participants were found to be insulin resistant. | 52 |
| Manios et al. (90) | Greece | Cross-sectional study | n = 2660 9–13 y old 50.6% males | Score range: 0–48.Mean ± SD: 17.12 ± 4.50. | A 1-unit increase in the HLD Index score was associated with 6% lower odds of obesity. | 72 | |
| PDL-Index | Manios et al. (38) | Greece | Cross-sectional study | n = 2287 2–5 y old 51.5% males | Score range: 0–44.Mean ± SD: 18.2 ± 4.8. | Participants in the third tertile of the PDL-Index were less likely to be overweight than those in the first tertile. | 52 |
| E-KINDEX | Lazarou et al. (92) | Greece | Cross-sectional study | n = 63410–13 y old No information on sex % | Score range: 1–87.Mean ± SD: 58.2 ± 7.8. | The highest E-KINDEX category (>60 points) was associated with 85% less likelihood of a child being obese or overweight and 86% less likelihood of having a WC >75th percentile.5 | 52 |
| HEI-1995 | Azadbakht et al. (84) | Iran | Cross-sectional study | n = 265 11–13 y old 100% females | Score range: 0–100.Mean ± SD: 63.90 ± 19.86. | HEI-1995 was not associated with BMI and blood pressure.5 | 62 |
| Drenowatz et al. (111) | USA | Cross-sectional study | n = 354Mean ± SD: 10.4 ± 0.4 y old 41.5% males | Score range: 0–100.Mean ± SD: 62.0 ± 8.9 | HEI-1995 was not associated with HDL cholesterol, blood pressure, and body fat. | 72 | |
| HEI-2005 | Loprinzi et al. (61) | USA | Cross-sectional study | n = 26296–17 y old No information on sex % | Score range: 0–100.Mean: 50.2 (children); 49.8 (adolescents) | A higher HEI-2005 score was associated with lower WC, C-reactive protein concentrations, and triglyceride concentrations. | 72 |
| Rydén and Hagfors (144) | Sweden | Cross-sectional study | n = 24944, 8, and 11 y old 51% males | Score range: 0–100.Mean ± SD: 59.99 ± 7.80 | — | 72 | |
| Torres et al. (145) | Puerto Rico | Cross-sectional study | n = 115012 y old 45.5% males | Score range: 0–100.Mean ± SD: 40.9 ± 0.9 | — | 72 | |
| He et al. (146) | Canada | Cross-sectional study | n = 81011–14 y old 49% males | Score range: 0–100.Mean ± SD: 39.1 ± 7.8 | — | 72 | |
| Burke et al. (147) | South Carolina | Cross-sectional study | n = 1719–15 y old 49.1% males | Score range: 0–100.Mean ± SD: 52.4 ± 0.85 | — | 62 | |
| HEI-2010 | Anderson Steeves et al. (148) | USA | Cross-sectional study | n = 2789–15 y old 47% males | Score range: 0–100.Mean ± SD: 55.5 ± 9.6 | — | 62 |
| Mellendick et al. (63) | USA | Cross-sectional study | n = 16316–17 y old 40% males | Score range: 0–100.Mean ± SD: 49.2 ± 12.0 | HEI-2010 had no association with BMI, WC, blood pressure, and lipid profile. | 72 | |
| Dave et al. (104) | USA | RCT 6 wk follow-up | n = 1209–12 y old 40.8% males | Score range: 0–100.Mean ± SD: 55.72 ± 1.98 (baseline intervention); 57.34 ± 1.79 (baseline control); 56.54 ± 1.99 (posttest cases); 53.74 ± 1.80 (posttest control) | No differences were found between the intervention group and the control group with regard to BMI after 6 wk of follow-up. | Low risk of bias4 | |
| Au et al. (149) | San Diego | Cross-sectional study | n = 3944 9.8 ± 0.7 y old 49.3% males | Score range: 0–100.Mean ± SD: 47.4 ± 11.9 | — | 72 | |
| Santiago-Torres et al. (150) | Spain | Cross-sectional study | n = 187 10–14 y old 47% males | Score range: 0–100.Mean ± SD: 59.4 ± 8.8 | — | 52 | |
| Arandia et al. (151) | Spain | Cross-sectional study | n = 14668–16 y old 50.7% males | Score range: 0–100.Mean: 53.8 | — | 72 | |
| Arcan et al. (152) | USA | RCT | n = 1608–12 y old 85% males | Score range: 0–100.Mean ± SD: 53.7 ± 11.3 | After the intervention, parents reported their children had half their plates filled with fruit and vegetables at dinner on average 2.7 times in the past week (although not related to the aims of this article). | High risk of bias4 | |
| Clennin et al. (83) | USA | Cross-sectional study | n = 828Mean ± SD: 10.6 ± 0.05 y old 45.3% males | Score range: 0–100.Mean ± SD: 30.1 ± 5.38 | — | 62 | |
| HEI-2010 adapted to Brazil | Horta et al. (153) | Brazil | Cross-sectional study | n = 1357 8–12 y old 51% males | Score range: 0–100.Mean: 51.8 | — | 72 |
| HEI-2010 adapted to Singapore Health Promotion Board | Brownlee et al. (105) | Malaysia | Cross-sectional study | n = 5616–12 y old 47.4% males | Score range: 0–100.Median (IQR) 65.4 (57.1; 73.0) | HEI had no association with BMI.5 | 42 |
| HEI-2015 | Hayuningtyas et al. (109) | Indonesia | Cross-sectional study | n = 85 3–5 y old 48.2% males | Score range: 0–100.Mean ± SD: 33.2 ± 8.3 | A 1-point increase in the HEI-2015 was associated with an increase in serum adiponectin. | 52 |
| Khan et al. (154) | USA | Cross-sectional study | n = 574 and 5 y old 59.6% males | Score range: 0–100.Mean ± SD: 54.2 ± 14.2 | — | 52 | |
| Hopkins et al. (155) | USA | Cohort study 4 months follow-up | n = 100 3–12 y old 53% males | Score range: 0–100.Mean ± SD: 46.51 ± 1.72 (baseline); 46.51 ± 1.27 (first phase); 51.13 ± 1.46 (second phase) | — | 66 | |
| YHEI | Gingras et al. (45) | USA | Cohort study 7.9 y follow-up | n = 10512 y old 50.3% males | Score range: 0–85.Mean ± SD: 55.4 ± 9.4 | — | 86 |
| Protudjer et al. (118) | Canada | Case–control study | n = 47612.6 ± 0.5 y old 56.7% males | Score range: 0–85.Median (IQR)33.85 (29.85; 38.12) | YHEI had no association with asthma. | 93 | |
| Diet Quality Index Canadian (DQI-C) | Jarman et al. (156) | Canada | Cross-sectional study | n = 12603 y old 52% males | Score range: 0–6.Mean ± SD: 3.69 ± 0.6 | — | 72 |
| Healthy Dietary Variety Index | Barros et al. (96) | Portugal | Cohort study | n = 3962 4 y old 51.5% males | Score range: 0–1.Mean ± SD: 0.78 ± 0.11 | The score was inversely related to BMI. | 86 |
| School Child Diet Index (ALES) | Molina et al. (157) | Brazil | Cross-sectional study | n = 12827–10 y old 42% males | Score range: −10 to 10.Mean ± SD: 4.3 ± 3.5.Low adherence/diet quality: 41% | — | 62 |
| Brazilian Healthy Eating Index Revised (BHEI-R) | Toffano et al. (158) | Brazil | Cross-sectional study | n = 1679–13 y old 47.3% males | Score range: 0–100.Median (IQR): 54.3 (31.0–81.0) | — | 52 |
| Wendpap et al. (110) | Brazil | Cross-sectional study | n = 1326 10–14 y old 50% males | Score range: 0–100.Median (IQR): 75.1 (74.8–75.5) | There was a positive association between the score and BMI.5 | 72 | |
| Prado et al. (159) | Brazil | Cross-sectional study | n = 2017–10 y old 43.5% males | Score range: 0–100.Mean ± SD: 62.4 ± 8.68 | — | 62 | |
| Recommended Food Score | Coelho et al. (103) | Brazil | Cross-sectional study | n = 6616–14 y old 52.2% males | Score range: 0–50.Mean ± SD: 16.00 ± 6.82.Low adherence: 77.2% (<80th percentile) | The score had no association with BMI. | 72 |
| Healthy Eating Index (Brazil) | Leal et al. (39) | Brazil | Cross-sectional study | n = 5562–5 y old 53.6% males | Score range: 0–100.Mean ± SD: 74.4 ± 0.4 | — | 62 |
| ACARFS | Marshall et al. (102) | Australia | Cross-sectional study | n = 69111.0 ± 1.1 y old 43.8% males | Score range: 0–73.Mean ± SD: 25 ± 13 | ACARFS was not related to BMI. | 72 |
| DGI-CA | Ping-Delfos et al. (64) | Australia | Cohort study 3 y follow-up | 14 y old n = 1419 51.4% males 17 y old n = 843 46.5% males | Score range: 0–100.Mean ± SD: 47.1 ± 10.4 (14 y); 47.7 ± 11.0 (17 y) | From baseline at 14 y to the follow-up at 17 y, DGI-CA was positively related to BMI and negatively related to waist-to-height ratio and triglyceride concentrations. No relation with blood pressure was found. | 86 |
| Golley et al. (123) | Australia | Cross-sectional study | n = 34164–16 y old No information on sex % | Score range: 0–100.Mean ± SD: 53.6 ± 0.4. | 8–11 y: There was no relation between the score and body mass and WC.4–10, 12–16 y: A positive relation was found between the score and BMI and WC. | 72 | |
| Prior derived Diet Quality Index | Lioret et al. (93) | Australia | Cohort study 3 y follow-up | n = 2165–12 y old 44% males | Score range: 0–100.Mean ± SD: 64.2 ± 10.3 (baseline); 59.7 ± 12.4 (posttest) | The score was inversely related to BMI only in children with overweight at baseline. | 86 |
| Australian Recommended Food Scores for Pre-Schoolers (ARFS-P) | Burrows et al. (160) | Australia | Cross-sectional study | n = 1462–5 y old 54% males | Score range: 0–73.Median (IQR)32.0 (22.9–42.0) | — | 62 |
| Revised Children's Diet Quality Index (RC-DQI) | Collins et al. (161) | Australia | RCT 3.5 y follow-up | n = 244 3.5 y old 50.4% males | Score range: 0–85.Mean ± SD: 62.8 ± 8.3 | — | High risk of bias4 |
| Dietary Index for a Child's Eating (DICE) | Delshad et al. (42) | New Zealand | Cross-sectional study | n = 65 2–8 y old 44.6% males | Score range: 0–100.Mean ± SD: 78.2 ± 11.5 | — | 42 |
| Modified version of Revised Children's Diet Quality Index (M-RCDQI) | Keshani et al. (162) | Iran | Cross-sectional study | n = 112413–15 y old 53.3% males | Score range: 0–90.Mean ± SD: 58.91 ± 8.58 | — | 72 |
| Diet Quality Index for Indian Children (DQIIC) | Chamoli et al. (163) | India | Cross-sectional study | n = 1007–9 y old 53% males | Unhealthy diet: 33%.Moderate diet quality: 41%.Healthy diet: 26% | — | 62 |
| Chinese's Children's Dietary Index (CCDI) | Zhang et al. (67) | China | Cross-sectional study | n = 20437–15 y old 51.6% males | Score range: 0–160.Mean ± SD: 88.9 ± 15.1 (adherence was positively associated with energy adjusted for diet cost) | — | 72 |
| Duan et al. (164) | China | Cohort study 4.2 y follow-up | n = 3983 Mean: 7 y old 56% males | Score range: 0–160.Male range: 56.2–136.3.Female range: 46.1–131.5 | — | 76 | |
| Japanese Food Guide Spinning Top Score (JFGST) | Shinsugi et al. (112) | Japan | Cross-sectional study | n = 110Mean ± SD: 4.8 ± 0.4 y old 51.6% males | Score range: 0–70.Mean ± SD: 55.7 ± 7.5 | There was no association between the score and waist-to-height ratio. | 72 |
| Malaysian Healthy Eating Index | Appannah et al. (106) | Malaysia | Cross-sectional study | n = 33713 y old 29% males | Score range: 0–100.Mean ± SD: 49.1 ± 14.5 | There was no association between the index and BMI, WC, or fasting blood glucose, cholesterol, and insulin concentrations. | 62 |
| Rezali et al. (165) | Malaysia | Cross-sectional study | n = 37613–16 y old 35.1% males | Score range: 0–100.Mean ± SD: 37.9 ± 9.1 | — | 72 | |
| OPLS | Papoutsakis et al. (91) | Greece | Cross-sectional study | n = 5145–11 y old No information on sex % | Score range: 0–18.Mean ± SD: 8.6 ± 2.9 (asthma cases); 9.3 ± 2.7 (control cases) | OPLS was negatively associated with BMI, WC, and hip circumference.A high OPLS was protective against diagnosed asthma. | 72 |
| HEI based on WHO guidelines | da Costa et al. (166) | Portugal | Cohort study 3 y follow-up | n = 50134 and 7 y old No information on sex % | Score range: 8–32.Mean ± SD: 21.4 ± 3.53 (4 y); 20.3 ± 3.36 (7 y) | — | 86 |
| DQI-I | Tur et al. (108) | Italy | Cross-sectional study | n = 164312.4 ± 0.4 y old 53.9% males | Score range: 0–100.Mean ± SD: 52.31 ± 8.89 | DQI-I was positively related to BMI. | 72 |
| Healthy Dietary Adherence Score | Arvidsson et al. (43) | European countries (Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain, and Sweden) | Cohort study 2 y follow-up | n = 76752–9 y old 51% males | High adherence: 52% | — | 56 |
| DDS | Jiang et al. (167) | China | Cross-sectional study | n = 6973–7 y old 50.6% males | Score range: 0–9.Mean ± SD: 7.0 ± 1.3 | — | 62 |
| Mak et al. (168) | Philippines | Cross-sectional study | n = 64606–12 y old 48.5% males | Score range: 0–9.Mean ± SD: 4.1 ± 1.3 | — | 62 | |
| Bi et al. (169) | China | Cross-sectional study | n = 1328 3 or 5 y old 51.6% males | Score range: 0–9.Median (IQR)5.77 (5.70–5.83). | — | 72 | |
| Zhao et al. (107) | China | Cross-sectional study | n = 1694 3–12 y old 51.8% males | Score range: 0–9.Mean ± SD: 6.3 ± 1.6 | There was no relation between DDS and BMI.5 | 52 | |
| Miller et al. (170) | Nepal | Case–control study | n = 26955.9 ± 6.5 months 46.8% males | Score range: 0–48.Mean: 26 points | — | 83 | |
| Cabalda et al. (44) | Philippines | Cross-sectional study | n = 200 2–6 y old No information on sex % | Score range: 0–10.Mean ± SD: 6.12 ± 0.17 (with garden); 5.62 ± 0.17 (without garden) | — | 62 | |
| HDS | Shang et al. (95) | China | Cross-sectional study | n = 56766–13 y old 46.6% males | HDS ≥ 8: 5.3%.HDS ≤ 3: 15.2% | An HDS ≥ 8 was inversely related to BMI, blood pressure, mean arterial pressure, fasting glucose and insulin concentrations, and HOMA values compared with HDS ≤ 3. | 72 |
1
ACARFS, Australian Child and Adolescent Recommended Food Score; ADHD, attention deficit hyperactivity disorder; BSDS, Baltic Sea Diet Score; CIDQ, Children's Index of Diet Quality; DASH, Dietary Approaches to Stop Hypertension; DDS, Dietary Diversity Score; DGI-CA, Dietary Guideline Index for Children and Adolescents; DQI-A, Diet Quality Index for Adolescents; DQI-I, Diet Quality Index International; E-KINDEX, Electronic Kids Dietary Index; fMDS, food frequency–based Mediterranean Diet Score; HDS, Healthy Diet Score; HLD Index, Healthy Lifestyle–Diet Index; HuSKY, Healthy Nutrition Score for Kids and Youth; KIDMED, Mediterranean Diet Quality Index for Children and Adolescents; MDS, Mediterranean Diet Score; NOS, Newcastle-Ottawa Scale; OPLS, Obesity-Preventive Lifestyle Score; PDL-Index, Preschoolers Diet–Lifestyle Index; RADDS, Riskmaten Adolescents Diet Diversity Score; SEAD, Southern European Atlantic Diet; SHEIA, Swedish Healthy Eating Index for Adolescents; WC, waist circumference; YHEI, Youth Healthy Eating Index.
2
The NOS for cross-sectional studies (varying from 0 to 8 stars).
3
The NOS for case–control studies (varying from 0 to 9 stars).
4
Tool of the Cochrane Collaboration for randomized control trials (low, medium, or high risk of bias).
5
Associations with outcomes obtained only by correlations.
6
The NOS for cohort studies (varying from 0 to 9 stars).