Development and Application of a Total Diet Quality Index for Toddlers.


For the first time, the 2020-2025 Dietary Guidelines for Americans include recommendations for infants and toddlers under 2 years old. We aimed to create a diet quality index based on a scoring system for ages 12 to 23.9 months, the Toddler Diet Quality Index (DQI), and evaluate its construct validity using 24 h dietary recall data collected from a national sample of children from the Feeding Infants and Toddlers Study (FITS) 2016. The mean (standard error) Toddler DQI was 49 (0.6) out of 100 possible points, indicating room for improvement. Toddlers under-consumed seafood, greens and beans, and plant proteins and over-consumed refined grains and added sugars. Toddler DQI scores were higher among children who were ever breastfed, lived in households with higher incomes, and who were Hispanic. The Toddler DQI performed as expected and offers a measurement tool to assess the dietary quality of young children in accordance with federal nutrition guidelines. This is important for providing guidance that can be used to inform public health nutrition policies, programs, and practices to improve diets of young children.





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Publication Info

Kay, Melissa C, Emily W Duffy, Lisa J Harnack, Andrea S Anater, Joel C Hampton, Alison L Eldridge and Mary Story (2021). Development and Application of a Total Diet Quality Index for Toddlers. Nutrients, 13(6). p. 1943. 10.3390/nu13061943 Retrieved from

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Melissa Kay

Assistant Professor of Pediatrics

Melissa Kay is a public health nutritionist conducting research in support of early life obesity prevention. Her educational background includes public health, food policy and applied nutrition, epidemiology, and nutrition interventions. She is currently faculty in the Department of Pediatrics and is using digital technologies to augment clinical care between primary care visits as well as visits with the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Using interactive text messaging, Dr. Kay supports caregivers in adopting healthy feeding behaviors for themselves and their families.  

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