Development and application of a total diet quality index for toddlers

Melissa C. Kay, Emily W. Duffy, Lisa J. Harnack, Andrea S. Anater, Joel C. Hampton, Alison L. Eldridge, Mary T Story

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Article number1943
Issue number6
StatePublished - Jun 5 2021

Bibliographical note

Funding Information:
Funding: The Feeding Infants and Toddlers Study was funded by Nestlé Research (Societé des Produits Nestlé, S.A.), Lausanne, Switzerland through a contract with RTI International and its subcontractor, the University of Minnesota. Salary support for M.C.K. was provided by the Duke Center for Research to Advance Healthcare Equity (REACH Equity), which is supported by the National Institute on Minority Health and Health Disparities under award number U54MD012530.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Child nutrition
  • Diet quality
  • Dietary guidelines
  • Dietary recommendations
  • Eating patterns
  • Healthy Eating Index
  • Toddlers

PubMed: MeSH publication types

  • Evaluation Study
  • Journal Article


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