Validation of the General Nutrition Knowledge Questionnaire in an Australian community sample

Aim:  To validate the General Nutrition Knowledge Questionnaire developed by Parmenter and Wardle (1999) in an Australian community sample. This questionnaire differs from previous assessments of knowledge because it incorporates a broad range of nutrition concepts, including knowledge of dietary recommendations, healthy food choices, nutrient sources and some diet–disease relationships.
Methods:  The original questionnaire was developed in the UK, and thus modified to suit the current Dietary Guidelines for Australians and current public health nutrition recommendations. A total of 156 people, of which 116 were community members, completed the questionnaire (113 items). As an indication of concurrent validity, a subsample of nutrition and dietetic students were included (n = 40). As a measure of test–retest reliability, a subsample (n = 57), including students and community members, answered the questionnaire on two occasions, two weeks apart.
Results:  Both overall internal reliability of the questionnaire items (Cronbach's alpha = 0.92) and test–retest reliability (r = 0.87) were high. The nutrition and dietetic students, hypothesised to have higher knowledge levels, scored consistently higher than the general community sample, indicating good concurrent validity.
Conclusion:  A test of a modified version of the General Nutrition Knowledge Questionnaire found it to be a valid and reliable measure of nutrition knowledge, appropriate for use in a section of the Australian community. The validated tool may be used in the future for the comprehensive assessment of general nutrition knowledge; however, further testing in differing sections of Australian society may be warranted.     

Healthy Eating Index-2015 Is Associated with Grip Strength among the US Adult Population

The Healthy Eating Index-2015 (HEI-2015) was designed to reflect adherence to the 2015–2020 Dietary Guidelines for Americans (DGA). The study aims to examine the association between HEI-2015 and grip strength in a nationally representative sample of the U.S. adult population. This cross-sectional study used data from the National Health and Nutrition Examination Surveys of 2011–2014. Low grip strength was defined as <35.5 kg for men and <20 kg for women. HEI-2015 was computed from two days of 24-h dietary recalls and comprised 13 components. Each component was scored on the density out of 1000 calories and summed to a total score divided into quartiles. Weighted logistic regressions examined the study aim while controlling for associated covariates. The sample included 9006 eligible participants, of those, 14.4% (aged 20+ years), and 24.8% (aged ≥50 years) had low grip strength. Mean (±SD) HEI-2015 total score was 54.2 ± 13.6 and in the lowest and highest quartiles 37.3 ± 5.1 and 72.0 ± 6.5, respectively. In the multivariable model, participants in the highest vs. lowest HEI-2015 quartile had 24% lower odds of having low grip strength (Odds Ratio (OR) = 0.76; 95% CI: 0.60–0.96). Specifically, participants who met the DGA for protein intakes, whole grains, greens and beans, vegetables, or whole fruits had 20–35% lower odds of having low grip strength than those who did not. Higher compliance to the DGA might reduce the risk for low grip strength as a proxy measure for sarcopenia among U.S. adults, particularly adequate intakes of proteins, whole grains, greens and beans, vegetables, and whole fruits.     

High Adherence to the Food Pyramid’s Recommendations Avoids the Risk of Insufficient Nutrient Intake among Farmers in Peri-Urban Kenya

This study aimed to investigate whether the Kenyan Food Pyramid (FP) can evaluate excess or insufficient nutrient intake. Participants were farmers (56 men and 64 women, aged 18–60 years) in Wangige Village, Kiambu County—a peri-urban area of Kenya. Cross-sectional data were collected for demographic characteristics, physical measurements, and 2-day and 24-h dietary recalls. The average adherence level to the FP (hereafter, “FP score”) was 25.0 out of 50.0, with a minimum and maximum of 14.1 and 41.5, respectively. Energy and protein % energy ratio were significantly higher (p for trend < 0.05) in the higher FP score group. A higher FP score was also associated with a higher energy-adjusted micronutrient intake, and it was more likely to meet nutrient requirements. However, the higher FP score group had a higher risk of excess sodium intake (p for trend < 0.001). The Kenyan FP could be a useful tool for avoiding the risk of insufficient nutrient intake, but not for avoiding high energy and sodium intake. It is necessary to include appropriate evaluations to limit energy, sugar, and salt. Food groups and recommendations of the FP should be optimised according to the dietary environment of the target population so as to promote their health.     

Twenty-Five-Year Trends in Dietary Patterns among Chinese Adults from 1991 to 2015

Poor dietary habits have been shown to be associated with a range of chronic diseases and can potentially be a major contributor to non-communicable diseases (NCDs) mortality. We therefore aimed to identify the prevailing dietary patterns among Chinese adults and to evaluate trends in dietary patterns from 1991 to 2015. We used data collected in the China Health and Nutrition Survey (CHNS). Dietary patterns were identified using factor analysis of data from three consecutive 24 h dietary recalls. We studied 29,238 adults aged 18 and above with complete demo-graphic and dietary data. Three distinct dietary patterns were identified: southern (high intakes of rice, vegetables, and pork), modern (high intakes of fruits, dairy products, cakes, cookies, and pastries), and meat (high intakes of organ meats, poultry, and other livestock meat). The southern pattern score decreased (mean ± SD scores in 1991: 0.11 ± 1.13; scores in 2015: −0.22 ± 0.93). The modern pattern score (mean ± SD scores in 1991: −0.44 ± 0.59; scores in 2015: 0.21 ± 1.01) and meat pattern score (mean ± SD scores in 1991: −0.18 ± 0.98; scores in 2015: 0.27 ± 0.91) increased. We observed that China has experienced a shift from traditional dietary patterns to western dietary patterns.     

Sociodemographic Factors Associated with Adherence to Dietary Guidelines in Women with Gestational Diabetes: A Cohort Study

Dietary advice is the cornerstone of care for women with gestational diabetes mellitus (GDM). However, adherence to this advice is variable. We aimed to identify the proportion of women with GDM who adhere to the New Zealand nutrition guideline recommendations and assess the sociodemographic factors linked to dietary adherence. We assessed dietary intake at 36 weeks’ gestation in a cohort of 313 women with GDM and compared this with the dietary recommendations for the management of GDM. Associations between maternal characteristics and dietary adherence were assessed using ANOVA, chi square, logistic regression, and linear regression tests. Women with GDM had an average adherence score of 6.17 out of 10 to dietary recommendations, but no one adhered to all the recommendations. Adherence to recommendations was lowest for saturated fat, and wholegrain breads and cereals. While 85% visited a dietitian, only 28% of women achieved their recommended weight gain. Maternal factors associated with lower dietary adherence were primiparity, no previous history of GDM, being underweight, and smoking. Adherence to the dietary recommendations by women with GDM in New Zealand for the management could be improved. Further research is needed to identify ways for women with GDM to improve their dietary adherence.     

Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients

BACKGROUND/OBJECTIVESThe current study examined trends in adherence to dietary recommendations and compared the levels of adherence between diagnosed and undiagnosed subjects with type 2 diabetes mellitus (T2DM) in Korea over the past 14 years.SUBJECTS/METHODSData were collected from the 1998-2012 Korea National Health and Nutrition Examination Surveys (KNHANES). Diagnosed diabetes was defined as giving a positive response to questions about awareness of the disease, a physician''s diagnosis of diabetes, or medical treatment for diabetes, whereas undiagnosed diabetes was defined as having a fasting glucose level ≥ 126 mg/dl. Assessment of adherence level was based on 6 components of dietary guidelines, considering meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol. The participants received 1 point if they met the criteria for each of the 6 components, and the total possible score ranged from 0 to 6 points. Multivariate generalized linear regression was performed, taking into account the complex survey design.RESULTSAmong all diabetic patients aged 30 years or older, the proportion of diagnosed diabetes increased dramatically, from 40.9% in 1998 to 75.9% in 2012 (P for trend < 0.001). The overall adherence levels to dietary recommendations were low and did not significantly differ between diagnosed and undiagnosed subjects with T2DM for all survey years. Several improvements were observed, including increased adherence to maintaining sufficient vegetable/seaweed consumption (increased from 0.12 to 0.16 points) and limiting sodium intake (increased from 0.12-0.13 points to 0.19-0.24 points; P for trend < 0.001), while adherence to maintaining moderate alcohol consumption decreased.CONCLUSIONSAnalysis of data collected by the KNHANES indicates that Korean T2DM patients have poor adherence to dietary recommendations and maintenance of a healthy lifestyle, regardless of disease awareness. This finding suggests that development of practical, evidence-based guidelines is necessary and that provision and expansion of educational programs for T2DM patients is critical after diagnosis.     

Relationships between Food Production Experience and the Behavior,Attitude, and Knowledge of Dietary Recommendations among Japanese Adults: A Cross-Sectional Study

The Japanese Ministry of Agriculture, Forestry, and Fisheries proposed to educate more people in food production as one of the objectives of the Basic Plan for Food and Nutrition Education Promotion. This cross-sectional study aims to elucidate the relationship between food production experience (agricultural, forestry, and fishery experiences) and the behavior, attitude, and knowledge of dietary recommendations among Japanese adults. This study was conducted using data obtained from the “Survey on Dietary Habits and Agriculture, Forestry, and Fishery Experiences (2019)”. This survey was conducted by mailing paper questionnaires to respondents aged 20–69 years living in 17 regions across Japan. The independent variable was food production experience. The dependent variables were each of the 13 goals of the dietary guidelines in Japan, the total score for adherence to the 13 items (low scores indicate good adherence), adherence to a Japanese-style diet, and four items on the attitude and knowledge of dietary recommendations. I also examined the association between the point in life the food production experience occurred and the above outcomes. The data obtained from 3461 participants aged 20 to 69 years were used for multivariate logistic and linear regression analyses. Food production experience was positively associated with an improved behavior, attitude, and knowledge of dietary recommendations among adults in Japan. The study found a strong relationship with food production experiences in adulthood.     

Egg Intake and Dietary Quality among Overweight and Obese Mexican-American Postpartum Women

Despite their low cost and high nutrient density, the contribution of eggs to nutrient intake and dietary quality among Mexican-American postpartum women has not been evaluated. Nutrient intake and dietary quality, as assessed by the Healthy Eating Index 2010 (HEI-2010), were measured in habitually sedentary overweight/obese (body mass index (BMI) = 29.7 ± 3.5 kg/m²) Mexican-American postpartum women (28 ± 6 years) and compared between egg consumers (n = 82; any egg intake reported in at least one of three 24-h dietary recalls) and non-consumers (n = 57). Egg consumers had greater intake of energy (+808 kJ (193 kcal) or 14%; p = 0.033), protein (+9 g or 17%; p = 0.031), total fat (+9 g or 19%; p = 0.039), monounsaturated fat (+4 g or 24%; p = 0.020), and several micronutrients than non-consumers. Regarding HEI-2010 scores, egg consumers had a greater total protein foods score than non-consumers (4.7 ± 0.7 vs. 4.3 ± 1.0; p = 0.004), and trends for greater total fruit (2.4 ± 1.8 vs. 1.9 ± 1.7; p = 0.070) and the total composite HEI-2010 score (56.4 ± 12.6 vs. 52.3 ± 14.4; p = 0.082). Findings suggest that egg intake could contribute to greater nutrient intake and improved dietary quality among postpartum Mexican-American women. Because of greater energy intake among egg consumers, recommendations for overweight/obese individuals should include avoiding excessive energy intake and incorporating eggs to a nutrient-dense, fiber-rich dietary pattern.     

Dietary Intake Patterns and Lifestyle Behaviors of Pregnant Women Living in a Manitoba First Nations Community: Implications for Fetal Alcohol Spectrum Disorder

The information on the nutrition status of women at-risk of carrying a child with fetal alcohol spectrum disorder (FASD) is scarce, particularly in the First Nations population living on reserve. This study examined and compared nutrition status, dietary intake, and lifestyle patterns of pregnant at-risk, defined as those who consume alcoholic drink during the current pregnancy, and non-at-risk women living in northern Manitoban community. Thirty-seven pregnant, First Nations women (at-risk n = 15; non-at-risk, n = 22) were recruited to participate in the study. A questionnaire, presented in paper and iPad formats, collected information on participants’ demographics, dietary intake, lifestyle, pregnancy outcomes, and maternal health. A food frequency questionnaire and 24-h recall were used to determine nutrient intake. Nutrient values were assessed using Dietary Reference Intakes (DRI). At-risk and non-at-risk women were below the Canada Food Guide serving size recommended for Vegetable and Fruit, Grain, and Milk Products with 93%, 92%, and 93% of participants not meeting the recommendations, respectively. Women met the recommendations for vitamins A, B1, B12, C, niacin, choline, as well as calcium, and zinc. Sixty eight percentage (%) of participants did not meet the recommendations for folate and iron, and 97% for docosahexaenoic acid (DHA). Significant differences were observed between non-at-risk and at-risk women for mean % DRI intakes of vitamin C (313 ± 224 vs. 172 ± 81 mg/day), niacin (281 ± 123 vs. 198 ± 80 mg/day), folate (70 ± 38 vs. 10 ± 22 mcg/day), and iron (101 ± 74 vs. 74 ± 30 mg/day). The findings of this study lay a fundamental premise for the development of community nutrition programs, nutrition education, and nutrition intervention, such as community specific prenatal supplementation. These will assist in ensuring adequate maternal nutrient intake and benefit families and communities in Northern Manitoba with and without alcohol insult.     

Metabolomics to Explore Impact of Dairy Intake

Dairy products are an important component in the Western diet and represent a valuable source of nutrients for humans. However, a reliable dairy intake assessment in nutrition research is crucial to correctly elucidate the link between dairy intake and human health. Metabolomics is considered a potential tool for assessment of dietary intake instead of traditional methods, such as food frequency questionnaires, food records, and 24-h recalls. Metabolomics has been successfully applied to discriminate between consumption of different dairy products under different experimental conditions. Moreover, potential metabolites related to dairy intake were identified, although these metabolites need to be further validated in other intervention studies before they can be used as valid biomarkers of dairy consumption. Therefore, this review provides an overview of metabolomics for assessment of dairy intake in order to better clarify the role of dairy products in human nutrition and health.     

The 2005 Dietary Guidelines for Americans Adherence Index: development and application

The sixth edition of the Dietary Guidelines for Americans (DGA) was released in January 2005, with revised healthy eating recommendations for all adult Americans. We developed the 2005 Dietary Guidelines Adherence Index (DGAI) as a measure of adherence to the key dietary intake recommendations. Eleven index items assess adherence to energy-specific food intake recommendations, and 9 items assess adherence to "healthy choice" nutrient intake recommendations. Each item was scored from a minimum of 0 to a maximum of 1, depending on the degree of adherence to the recommendation. A score of 0.5 was given for partial adherence on most items or for exceeding the recommendation for energy-dense food items. The DGAI was applied to dietary data collected at the fifth examination of the Framingham Heart Study Offspring Cohort. The mean DGAI score was 9.6 (range 2.5-17.50). Those with higher DGAI scores were more likely to be women, older, multivitamin supplement users, and have a lower BMI and less likely to be smokers. The DGAI demonstrated a reasonable variation in this population of adult Americans, and by design this index was independent of energy consumption. The DGAI also demonstrated face validity based on the observed associations of the index with participant characteristics. Given these attributes, this index should provide a useful measure of diet quality and adherence to the new 2005 Dietary Guidelines for Americans.     

French-language adaptation of an evaluation test of knowledge meant for insulin-dependent children: methodology and value for research in clinical practice]

A measure of knowledge level of diabetic patients is useful in evaluating their educational needs as well as the impact of the educational programs specifically designed for them. The lack of such scales in French, led us to translate and validate an existing knowledge scale for diabetic children, the Test of Diabetes Knowledge (TDK) (Johnson et al.). After several translations and back translations, the 33 item scale was submitted to the staff members of a pediatric diabetology unit, to establish its content validity. An assessment the questionnaire was performed in a group of 49 children, aged 7.9 to 12.8 years. The mean duration of diabetes was 4.6 +/- 2.9 years and their scholastic level varied from 1st to 6th grades. Time spent in filling out the questionnaires was 12 to 25 minutes. Few missing values were noted. The reliability of the scale was excellent as shown by Cronbach's alpha coefficient: 0.83 for the overall scale, 0.72 for the general knowledge subscale (20 items) and 0.70 for the problem solving subscale (13 items). The level of correct responses was correlated with age and scholastic level (p < 0.0001), but not with sex, duration of diabetes, or HbA1c levels. This study shows that the French version of the TDK is a valid and reliable tool for measuring the level of knowledge in children and adolescents with diabetes. This scale provides the researcher and clinician with a tool that facilitates the performance of an educational diagnosis and the evaluation of educational programs based on the transmission knowledge.     

Development,Validation, and Reproducibility of Food Group-Based Frequency Questionnaires for Clinical Use in Brazil: A Pre-Hypertension and Hypertension Diet Assessment

The Blood pressure control diet is well described; however, it has not been implemented in clinical care, possibly due to the impracticability of the diet assessment in these contexts. In order to facilitate the dietary assessment, we developed and assessed the validity and reproducibility of two food group-based food frequency questionnaires (FG-FFQs), with a one-week (7-day FG-FFQ) and a one-month (30-day FG-FFQ) period of coverage for patients with pre-hypertension or hypertension. In 2010, 155 men and women, 30–70 years old, were invited to participate in a prospective study in two outpatient clinics in Porto Alegre, southern Brazil. The participants responded to two 30-day, two 7-day FG-FFQ, four 24-h dietary recalls, and underwent demographic, anthropometric, and blood pressure assessments. The validity and reproducibility were assessed using partial correlation coefficients adjusted for sex and age, and the internal validity was tested using the intra-class correlation coefficient. The participants were aged 61 (±10) years and 60% were women. The validity correlation coefficient was higher than r = 0.80 in the 30-day FG-FFQ for whole bread (r = 0.81) and the 7-day FG-FFQ for diet/light/zero soda and industrialized juices (r = 0.84) in comparison to the 24-h dietary recalls. The global internal validity was α = 0.59, but it increased to α = 0.76 when 19 redundant food groups were excluded. The reproducibility was higher than r = 0.80 for pasta, potatoes and manioc, bakery goods, sugar and cocoa, and beans for both versions. The 30-day had a slightly higher validity, both had good internal validity, and the 7-day FG-FFQ had a higher reproducibility.     

DIetary ASSessment (DIASS) Study: Design of an Evaluation Study to Assess Validity,Usability and Perceived Burden of an Innovative Dietary Assessment Methodology

During recent years, the integration of technology has substantially improved self-reported dietary assessment methods, such as food frequency questionnaires (FFQ), food records, and 24-h recalls. To further reduce measurement error, additional innovations are urgently needed. Memory-related measurement error is one of the aspects that warrants attention, which is where new smartphone technologies and ecological momentary assessment (EMA) approaches provide a unique opportunity. In this article, we describe the DIASS study, which was designed to evaluate an innovative 2-h recall (2hR) smartphone-based methodology, against traditional 24-h recalls, FFQ, and biomarkers, to assess both actual and habitual dietary intake. It is hypothesized that a 2-h reporting window decreases reliance on memory and reporting burden, and increases data accuracy. We included 215 men (28%) and women (72%), with a mean ± SD age of 39 ± 19 years and a mean ± SD BMI of 23.8 ± 4.0. Most participants were highly educated (58%). Response rates for the various dietary assessment methods were >90%. Besides the evaluation of the accuracy, usability, and perceived burden of the 2hR methodology, the study set-up also allows for (further) evaluation of the other administrated dietary assessment tools.     

Evaluation of Three Short Dietary Instruments to Assess Fruit and Vegetable Intake: The National Cancer Institute's Food Attitudes and Behaviors Survey

BackgroundFruit and vegetable (F/V) intake assessment tools that are valid, reliable, brief, and easy to administer and code are vital to the field of public health nutrition.ObjectiveTo evaluate three short F/V intake screeners (ie, a 2-item serving tool, a 2-item cup tool, and a 16-item F/V intake screener) among adults using multiple 24-hour dietary recalls (24-hour recalls) as the reference instrument and evaluate test–retest reliability of the screeners across a 2- to 3-week time period.DesignValidity and reliability study.Participants/settingTwo hundred forty-four adults for the validity study and 335 adults for test–retest reliability.Statistical analyses performedMedian values for F/V intakes were calculated for the screeners and 24-hour recalls. The Wilcoxon signed rank test was used to compare screeners with the 24-hour recalls. Deattenuated Pearson correlations were reported for validity and intraclass correlation coefficient used for reliability.ResultsThe estimated median daily servings/cups of F/V for the 2-item serving screener was lower, for the 2-item cup screener was equivalent for men but higher for women, and for the 16-item F/V intake screener were about the same when compared with 24-hour recall values. The deattenuated correlations comparing the 24-hour recalls with the screeners were positive but weak for the 2-item serving screener, and were positive and moderate in strength for the 2-item cup and 16-item F/V intake screeners. The test–retest intraclass correlation coefficients were all positive and fairly strong for all of the screeners.ConclusionsAlthough dietary screeners offer a more cost-effective, less burdensome way to obtain gross estimates to rank individuals with regard to F/V intake, these methods are not recommended for assessing precise intake levels.     

Adherence to the Mediterranean Diet in College Students: Evaluation of Psychometric Properties of the KIDMED Questionnaire

No prior studies have examined the reliability properties of the 16-item Mediterranean Diet Quality Index (KIDMED) questionnaire among young adults from a non-Mediterranean country. The objective of this study was to determine the psychometric properties in terms of the reliability and validity of the KIDMED questionnaire in young adults from Colombia. A cross-sectional validation study was conducted among 604 Colombian college students (47.51% men and 52.48% women; mean age of 21.60 ± 2.02 years). Kappa statistics were used to assess the reliability of the KIDMED questionnaire. A categorical principal components analysis was used to determine validity. Based on the KIDMED score, 58.4% of students had a good adherence to the Mediterranean diet (MedDiet). Good agreement in the general score of the questionnaire was observed (κ = 0.727, 95% confidence interval = 0.676 to 0.778, p < 0.001). A five-factor model was identified which explained almost 51.38% of the variability, showing the multidimensionality of the questionnaire. In conclusion, this study provides reasonable evidence for the reliability and validity of the KIDMED questionnaire for assessing adherence to MedDiet in college students within a Latin American country. The evaluation of the psychometric properties of this tool in early adulthood and in a non-Mediterranean country will be useful in clinical practice and epidemiological research, since practitioners and health researchers now have a valid and reliable short scale.     

Assessing Health-Related Quality of Life in Children with Coeliac Disease: The Italian Version of CDDUX

We aimed to assess Health-Related Quality of Life (HRQoL) of Italian children and their parents with coeliac disease (CD) using the Coeliac Disease Dutch Questionnaire (CDDUX). The CDDUX underwent a cross-cultural adaptation in a multi-step process, according to international guidelines. A total of 224 children aged between 8–18 years and their parents were prospectively recruited. Cronbach α coefficient was determined as a measure of internal consistency of the questionnaire and inter-children/parent reliability by intraclass correlation coefficient. Univariate and bivariate regression models were used to evaluate correlations between clinical variables and children and parents subclasses of CDDUX and overall mean Paediatric Quality of Life Inventory (PedsQL). The Italian CDDUX proved to be valid and reliable, mean CDDUX total score revealing a neutral evaluation of the quality of life in children 52.6 ± 17.2 and parents 49.5 ± 17.9 (p = 0.07) with strong correlation with PedsQL. The only clinical variable which appeared to affect significantly quality of life both in children and parents was the lower age. A comparison with our results showed remarkable differences in the HRQoL of populations of various nationalities. The Italian version of the CDDUX questionnaire is a simple and reliable tool for assessing the HRQoL in children and adolescents with CD.     

Adhering to Canada’s Food Guide Recommendations on Healthy Food Choices Increases the Daily Diet Cost: Insights from the PREDISE Study

The aim of this study was to assess the association between daily diet costs and the Healthy Eating Food Index (HEFI)-2019, an index that reflects the alignment of dietary patterns to recommendations on healthy food choices in the 2019 Canada’s Food Guide (CFG). Dietary intake data from 24 h recalls, completed between 2015 and 2017, of 1147 French-speaking participants of the web-based multicenter cross-sectional PRÉDicteurs Individuels, Sociaux et Environnementaux (PREDISE) study in Quebec were used. Diet costs were calculated from dietary recall data using a Quebec-specific 2015–2016 Nielsen food price database. Usual dietary intakes and diet costs were estimated using the National Cancer Institute’s multivariate method. Linear regression models were used to evaluate associations between diet costs and HEFI-2019 scores. When standardized for energy intake, a higher HEFI-2019 score (75th vs. 25th percentiles) was associated with a 1.09 $CAD higher daily diet cost (95% CI, 0.73 to 1.45). This positive association was consistent among different sociodemographic subgroups based on sex, age, education, household income, and administrative region of residence. A higher daily diet cost was associated with a higher HEFI-2019 score for the Vegetables and fruits, Beverage, Grain foods ratio, Fatty acids ratio, Saturated fats, and Free sugars components, but with a lower score for the Sodium component. These results suggest that for a given amount of calories, a greater adherence to the 2019 CFG recommendations on healthy food choices is associated with an increased daily diet cost. This highlights the challenge of conciliating affordability and healthfulness when developing national dietary guidelines in the context of diet sustainability.