Introduction
Self-rated health has been extensively studied, but the utility of a similarly structured
question to rate diet quality is not well characterized. This study aims to assess
the relative validity of self-rated diet quality, compared with that of a validated
diet quality measure (Healthy Eating Index-2015) and to examine the associations with
cardiometabolic risk factors.
Methods
Analyses were conducted in 2020–2021 using cross-sectional data from the National
Health and Nutrition Examination Survey, 2011–2018. Nonpregnant adults who responded
to the question: How healthy is your overall diet? and provided 2 dietary recalls were eligible (n=16,913). Associations between self-rated diet quality (modeled as a 5-point continuous
variable, poor=1 to excellent=5) and Healthy Eating Index-2015 scores and cardiometabolic
risk factors were assessed by linear regression, accounting for the complex survey
design and adjusting for demographic and lifestyle characteristics.
Results
Self-rated diet quality was positively associated with total Healthy Eating Index-2015
scores (p < 0.001) and with all components except with Dairy (p=0.94) and Sodium (p=0.66). Higher self-rated diet quality was associated with lower BMI, waist circumference,
glucose, insulin, triglycerides, and HbA1c and with higher high-density lipoprotein
cholesterol (all p<0.01). Positive associations with total diet quality persisted across all racial/ethnic
groups, although the associations with individual dietary components varied. Higher
self-ratings were most consistently associated with better-scored diet quality among
individuals with BMI <30 kg/m2.
Conclusions
Self-rated diet quality was associated with Healthy Eating Index-2015 scores and cardiometabolic
disease risk factors. This single-item assessment may be useful in time-limited settings
to quickly and easily identify patients in need of dietary counseling to improve cardiometabolic
health.
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Article Info
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Published online: July 07, 2021
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
