The Relationship between Nutrient-Rich Foods (NRF) Index as A Measure of Diet Quality and Malnutrition in Children

Background: The assessment of pediatric diet quality is of high interest because food habits that develop in childhood can predict adult diet-related disease. The aim of this study was to examine the association between the Nutrient-Rich Foods (NRF) index score and weight and height status. Methods: This cross-sectional study was conducted in primary schools of Tehran, and the NRF9.3 algorithms were used to estimate the nutrient density of the diet of 400 girls, aged 6.5-8.4 years. Dietary data were collected using a 168-item food frequency questionnaire of foods consumed over the past month. Height and weight were measured, and height for age, body mass index (BMI) for age, and weight for age were classified using the World Health Organization's child growth standard Z-scores. Linear regression was used to examine the association between the quintiles of NRF index score and weight for age, height for age, and BMI for age. Results: Liquid oil (P < 0.001), legume (P = 0.037), meat products (P = 0.005), and fruit (P < 0.001) were consumed in higher amounts significantly in the fifth quintile, while sugar & sweet sauce (P < 0.001), snacks (P = 0.002), fats, oil and savoury sauce (P = 0.002) were consumed in lower amounts significantly. A significant relationship between the NRF9.3 index and height for age (P = 0.039) was found, however, it did not follow a trend. The NRF9.3, NR9, and LIM3 scores were unrelated to weight status in childhood. Conclusion: There was no significant association between the NRF9.3 index score and malnutrition in girls, except for height for age. Bias in reporting the dietary intake or defects in the NRF index formula might be the reason for this insignificant result. Prospective studies can better detect the existence of such a relationship