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The Diet Quality Index-Revised: A Tool to Promote and Evaluate Dietary Change among Older Cancer Survivors Enrolled in a Home-Based Intervention Trial

https://doi.org/10.1016/j.jada.2007.06.014Get rights and content

Abstract

Objective

To utilize the Diet Quality Index-Revised (DQI-R) as a framework for delivering and evaluating an intervention to improve overall diet quality among older cancer survivors.

Design

As part of a randomized controlled trial to improve lifestyle behaviors among older cancer survivors, we sought a dietary measure that could serve as both an intervention framework and a means to evaluate global dietary quality. The DQI-R measures overall diet quality by summing 10 subscales that relate to national guidelines. At baseline, DQI-R scores were generated from three multi-pass 24-hour dietary recalls. The 6-month intervention delivered tailored feedback on individual DQI-R subscales. Dietary recalls were repeated at 6 and 12 months.

Subjects

Elderly (aged ≥65 years) individuals within 18 months of diagnosis of breast or prostate cancer (n=182) were randomized postbaseline measures to intervention vs attention control arms.

Results

Significant differences in overall diet quality were observed between arms at 6 months, with the intervention arm improving (67.6±12.2 to 69.8±13.9), and controls declining (67.5±12.5 to 64.6±14.7) (P=0.003). Significant differences were observed between arms over time in dietary diversity subscale scores: baseline and 6-month follow-up means among intervention and control arms were 4.8±1.3 to 4.8±1.4, and 4.7±1.2 to 4.1±1.1, respectively (P=0.001).

Conclusions

The DQI-R served as an effective guide and evaluation tool for this diet-related randomized controlled trial. Like many interventions, our effect diminished after the intervention was complete. Future research should consider testing interventions that use the DQI-R, or other global diet-related indexes, as guides and evaluation tools over longer study periods, as well as in other populations.

Section snippets

Subjects

The methods for this trial have been detailed elsewhere (21). In brief, 2,010 older adults within 18 months of diagnosis with loco-regional prostate or female breast cancer were identified through cancer registries, physician’s offices, and self-referral, and were invited into this trial after permission was received from their oncology care physicians (see Figure 1). The trial complied with Health Insurance Portability and Accountability Act of 1996 guidelines and was approved by the Duke

Results

A total of 182 people were accrued into this trial. Study participants were predominantly white, married, female, and from moderate-income households. The sample also was well-educated because 67% had education beyond high school, compared to 59% of elders reported by the US Bureau of Statistics (36). Furthermore, their quality of life scores were high. Like many survivors of breast and prostate cancer (12), most were overweight. There were no significant differences between arms with regard to

Discussion

Although several cross-sectional studies have quantified diet quality using global dietary indexes (1, 2, 4, 5, 13, 14, 15, 17, 18, 25, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49) and a handful of dietary intervention studies have used global diet quality as an outcome measure (50, 51, 52, 53), to our knowledge this is one of the first trials that has used a global diet quality index as both an intervention strategy and an evaluation tool. The only other study to report such methodology

Conclusions

The DQI-R was helpful in guiding dietary counseling and measuring overall diet quality for this randomized controlled trial. Recent changes in the Dietary Guidelines (61) include focusing on specific fats (consuming more unsaturated than saturated or trans fats) rather than total fat. Refining diet quality measures to focus on quality nutrient sources (fish and white meats replacing red meats and whole grains over refined breads) may improve current measures. Using indexes encompassing multiple

D. C. Snyder is a clinical trials manager, School of Nursing, R. Sloane is a biostatistician, Center for Study of Aging and Human Development, C. Pieper is an assistant professor, department of Biometry and Bioinformatics, and W. Demark-Wahnefried is a professor, School of Nursing and Department of Surgery, Duke University, Durham, NC.

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    D. C. Snyder is a clinical trials manager, School of Nursing, R. Sloane is a biostatistician, Center for Study of Aging and Human Development, C. Pieper is an assistant professor, department of Biometry and Bioinformatics, and W. Demark-Wahnefried is a professor, School of Nursing and Department of Surgery, Duke University, Durham, NC.

    E. C. Clipp is a professor of nursing and medicine, Duke University, Durham, NC, and a nurse scientist, Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, NC.

    M. C. Morey is an associate research professor of medicine, Duke University, Durham, NC, and associate director for research, Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, NC.

    H. Cohen is a chair and professor, Department of Medicine, and director, Center for the Study of Aging, Duke University Medical Center, Durham, NC.

    P. S. Haines is an associate professor, Department of Nutrition, University of North Carolina at Chapel Hill.

    P. Miller is a doctoral candidate, Department of Nutritional Sciences, The Pennsylvania State University, University Park; at the time of the study, she was a research assistant, Department of Surgery, Duke University, Durham, NC.

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